title: The role of adrenal scintigraphy in the diagnosis of subclinical Cushing's syndrome and the prediction of post-surgical hypoadrenalism.
abstract: BACKGROUND
  Management of subclinical Cushing's syndrome (SCS) remains controversial; it is not possible to predict which patients would benefit from adrenalectomy. In the present study we aimed to evaluate the role of adrenocortical scintigraphy (ACS) in the management of patients with SCS.
  
  
  METHODS
  The medical records of 33 consecutive patients with adrenal "incidentaloma" and proven or suspected SCS who underwent (131)I-19-iodocholesterol ACS between 2004 and 2010 were reviewed. Sixteen underwent laparoscopic adrenalectomy (surgical group-S-group) and 17 were medically managed (medical group-M-group). Follow-up evaluation was obtained by outpatient consultation.
  
  
  RESULTS
  Overall 25 patients (15 in the S-group and 10 in the M-group) had concordant unilateral uptake at ACS (ACS+). In the S-group, the mean follow-up duration was 30.9 ± 16.1 months and, irrespective of the presence of hormonal diagnosis of SCS, in patients who were ACS+ adrenalectomy resulted in a significant increase in HDL cholesterol and decreases in body mass index, glycemia, and blood pressure (BP). One patient reduced antihypertensive medication and three others were able to discontinue it altogether. Prolonged postoperative hypoadrenalism (PH) occurred in 14 patients in the S-group. The overall accuracy in predicting PH was 93.7 % for ACS and 68.7 % for laboratory findings. In the M-group, the mean follow-up duration was 31.5 ± 26.3 months and no patient developed overt Cushing's syndrome, although ACS+ patients experienced a worsening in glycemia and diastolic BP.
  
  
  CONCLUSIONS
  Adrenal scintigraphy seems the most accurate diagnostic test for SCS. It is able to predict the metabolic outcome and the occurrence of PH, identifying the patients who could benefit from adrenalectomy irrespective of hormonal diagnosis.
authors.affiliation: Units of Endocrinology, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy.
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Ricciato
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Di Donna
authors.forename: Germano
authors.initials: G
authors.lastname: Perotti
authors.forename: Alfredo
authors.initials: A
authors.lastname: Pontecorvi
authors.forename: Rocco
authors.initials: R
authors.lastname: Bellantone
authors.forename: Salvatore M
authors.initials: SM
authors.lastname: Corsello
mesh_terms: D015071:19-Iodocholesterol; D000310:Adrenal Gland Neoplasms / Q000473:pathology / Q000601:surgery; D000309:Adrenal Insufficiency / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D000315:Adrenalectomy / Q000009:adverse effects* / Q000379:methods; D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D003480:Cushing Syndrome / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D018570:Risk Assessment; D012380:Role; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome
chemical_list: D015071:19-Iodocholesterol