title: Screening for ACTH-dependent hypercortisolism in patients affected with pituitary incidentaloma.
abstract: BACKGROUND
  Pituitary incidentalomas (PIs) are commonly encountered in clinical practice. The management of these asymptomatic pituitary lesions is still controversial. Systematic screening for subclinical or mild ACTH-dependent hypercortisolism (AH) is not presently recommended, due to the limited data available thus far on the epidemiological and clinical relevance of this condition in patients with PIs. As subclinical hypercortisolism (SH) was considered to be associated with chronic complications of overt cortisol excess, such as hypertension, diabetes, and osteoporosis, this disorder should be diagnosed at the early stage.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the prevalence of hypercortisolism in a population of subjects with PIs.
  
  
  METHODS
  A total of 68 consecutive patients (48 females and 20 males, aged 18-82 years) without clinically overt hypercortisolism, who were referred for evaluation of PIs between January 2010 and March 2013, were prospectively investigated for AH. Pituitary hypercortisolism was diagnosed in the presence of cortisol >50 nmol/l after 1 mg dexamethasone suppression test, non-suppressed ACTH, and the additional finding of one of the following: urinary free cortisol (UFC) >193 nmol/24 h, and midnight serum and salivary cortisol levels >207 and 2.8 nmol/l respectively.
  
  
  RESULTS
  Among patients with PIs, we found a 7.3% rate of pituitary hypercortisolism diagnosed with biochemical criteria and a 4.4% rate of histologically confirmed AH.
  
  
  CONCLUSIONS
  Subclinical or mild hypercortisolism may be more common than generally perceived in patients with PIs.
authors.affiliation: Endocrinology and Diabetology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyMultimedica GroupUnit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, Milan, ItalyBIOMETRA DepartmentIRCCS Istituto Clinico Humanitas, University of Milan, Rozzano, Milan, Italy Endocrinology and Diabetology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyMultimedica GroupUnit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, Milan, ItalyBIOMETRA DepartmentIRCCS Istituto Clinico Humanitas, University of Milan, Rozzano, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Toini
authors.affiliation: Endocrinology and Diabetology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyMultimedica GroupUnit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, Milan, ItalyBIOMETRA DepartmentIRCCS Istituto Clinico Humanitas, University of Milan, Rozzano, Milan, Italy Endocrinology and Diabetology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyMultimedica GroupUnit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, Milan, ItalyBIOMETRA DepartmentIRCCS Istituto Clinico Humanitas, University of Milan, Rozzano, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Dolci
authors.affiliation: Endocrinology and Diabetology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyMultimedica GroupUnit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, Milan, ItalyBIOMETRA DepartmentIRCCS Istituto Clinico Humanitas, University of Milan, Rozzano, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Ferrante
authors.affiliation: Endocrinology and Diabetology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyMultimedica GroupUnit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, Milan, ItalyBIOMETRA DepartmentIRCCS Istituto Clinico Humanitas, University of Milan, Rozzano, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Verrua
authors.affiliation: Endocrinology and Diabetology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyMultimedica GroupUnit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, Milan, ItalyBIOMETRA DepartmentIRCCS Istituto Clinico Humanitas, University of Milan, Rozzano, Milan, Italy Endocrinology and Diabetology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyMultimedica GroupUnit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, Milan, ItalyBIOMETRA DepartmentIRCCS Istituto Clinico Humanitas, University of Milan, Rozzano, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Malchiodi
authors.affiliation: Endocrinology and Diabetology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyMultimedica GroupUnit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, Milan, ItalyBIOMETRA DepartmentIRCCS Istituto Clinico Humanitas, University of Milan, Rozzano, Milan, Italy Endocrinology and Diabetology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyMultimedica GroupUnit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, Milan, ItalyBIOMETRA DepartmentIRCCS Istituto Clinico Humanitas, University of Milan, Rozzano, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Sala
authors.affiliation: Endocrinology and Diabetology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyMultimedica GroupUnit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, Milan, ItalyBIOMETRA DepartmentIRCCS Istituto Clinico Humanitas, University of Milan, Rozzano, Milan, Italy.
authors.forename: A G
authors.initials: AG
authors.lastname: Lania
authors.affiliation: Endocrinology and Diabetology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyMultimedica GroupUnit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, Milan, ItalyBIOMETRA DepartmentIRCCS Istituto Clinico Humanitas, University of Milan, Rozzano, Milan, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Chiodini
authors.affiliation: Endocrinology and Diabetology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyMultimedica GroupUnit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, Milan, ItalyBIOMETRA DepartmentIRCCS Istituto Clinico Humanitas, University of Milan, Rozzano, Milan, Italy Endocrinology and Diabetology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyMultimedica GroupUnit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, Milan, ItalyBIOMETRA DepartmentIRCCS Istituto Clinico Humanitas, University of Milan, Rozzano, Milan, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Beck-Peccoz
authors.affiliation: Endocrinology and Diabetology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyMultimedica GroupUnit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, Milan, ItalyBIOMETRA DepartmentIRCCS Istituto Clinico Humanitas, University of Milan, Rozzano, Milan, Italy Endocrinology and Diabetology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyMultimedica GroupUnit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, Milan, ItalyBIOMETRA DepartmentIRCCS Istituto Clinico Humanitas, University of Milan, Rozzano, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Arosio
authors.affiliation: Endocrinology and Diabetology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyMultimedica GroupUnit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, Milan, ItalyBIOMETRA DepartmentIRCCS Istituto Clinico Humanitas, University of Milan, Rozzano, Milan, Italy Endocrinology and Diabetology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyMultimedica GroupUnit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, Milan, ItalyBIOMETRA DepartmentIRCCS Istituto Clinico Humanitas, University of Milan, Rozzano, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Spada
authors.affiliation: Endocrinology and Diabetology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyMultimedica GroupUnit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, Milan, ItalyBIOMETRA DepartmentIRCCS Istituto Clinico Humanitas, University of Milan, Rozzano, Milan, Italy Endocrinology and Diabetology UnitFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyMultimedica GroupUnit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, Milan, ItalyBIOMETRA DepartmentIRCCS Istituto Clinico Humanitas, University of Milan, Rozzano, Milan, Italy giovanna.mantovani@unimi.it.
authors.forename: G
authors.initials: G
authors.lastname: Mantovani
mesh_terms: D049913:ACTH-Secreting Pituitary Adenoma / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D000236:Adenoma / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D047748:Pituitary ACTH Hypersecretion / Q000175:diagnosis* / Q000453:epidemiology*; D055815:Young Adult