title: Abnormal Responsiveness to Dexamethasone-Suppressed CRH Test in Patients With Bilateral Adrenal Incidentalomas.
abstract: BACKGROUND
  The bilateral formation of nodules indicates that the pathogenesis of bilateral adrenal incidentalomas (AI) may differ from that of unilateral AI. A possible role of hypothalamo-pituitary-adrenal (HPA) axis dysregulation in their formation has not been investigated.
  
  
  OBJECTIVE
  The objective of the study was to evaluate the presence of altered feedback regulation of HPA axis in patients with bilateral AI.
  
  
  METHODS
  The dexamethasone (DEX) suppression-CRH test was used to assess ACTH and cortisol responses in controls and patients with unilateral and bilateral AI.
  
  
  METHODS
  The study was conducted at endocrine departments of two tertiary centers.
  
  
  METHODS
  We studied 24 controls and 39 patients with unilateral and 46 with bilateral AI.
  
  
  METHODS
  All subjects underwent standard low-dose dexamethasone suppression followed by iv bolus administration of human CRH (100 μg).
  
  
  RESULTS
  Bilateral AI had higher levels of ACTH and cortisol after the DEX-CRH challenge compared with both controls (P < .01 for ACTH and P < .001 for cortisol) and unilateral AI (P < .01 for ACTH and cortisol). A positive response, defined as peak ACTH greater than 10 pg/mL at 15 and/or 30 minutes followed by a significant rise in cortisol levels, was noted in 41.3% of bilateral vs 2.6% in unilateral AI (P < .001). Bilateral responders did not differ from nonresponders in demographic or hormonal characteristics, but they had larger total adrenal size compared with nonresponders.
  
  
  CONCLUSIONS
  A significant proportion of patients with bilateral AI demonstrate positive responses to the DEX-CRH test compared with unilateral AI, providing ground for potential involvement of HPA axis dysregulation in the pathogenesis, in at least a subgroup, of bilateral AI patients.
authors.affiliation: Department of Endocrinology, Diabetes, and Metabolism (D.A.V., M.T., V.T., E.M., M.T., S.T.), Evangelismos Hospital, 10676 Athens, Greece; and Department of Endocrinology, Diabetes, and Metabolism (N.M., G.P.), G. Genimatas Hospital, 11527 Athens, Greece.
authors.forename: D A
authors.initials: DA
authors.lastname: Vassiliadi
authors.affiliation: Department of Endocrinology, Diabetes, and Metabolism (D.A.V., M.T., V.T., E.M., M.T., S.T.), Evangelismos Hospital, 10676 Athens, Greece; and Department of Endocrinology, Diabetes, and Metabolism (N.M., G.P.), G. Genimatas Hospital, 11527 Athens, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Tzanela
authors.affiliation: Department of Endocrinology, Diabetes, and Metabolism (D.A.V., M.T., V.T., E.M., M.T., S.T.), Evangelismos Hospital, 10676 Athens, Greece; and Department of Endocrinology, Diabetes, and Metabolism (N.M., G.P.), G. Genimatas Hospital, 11527 Athens, Greece.
authors.forename: V
authors.initials: V
authors.lastname: Tsatlidis
authors.affiliation: Department of Endocrinology, Diabetes, and Metabolism (D.A.V., M.T., V.T., E.M., M.T., S.T.), Evangelismos Hospital, 10676 Athens, Greece; and Department of Endocrinology, Diabetes, and Metabolism (N.M., G.P.), G. Genimatas Hospital, 11527 Athens, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Margelou
authors.affiliation: Department of Endocrinology, Diabetes, and Metabolism (D.A.V., M.T., V.T., E.M., M.T., S.T.), Evangelismos Hospital, 10676 Athens, Greece; and Department of Endocrinology, Diabetes, and Metabolism (N.M., G.P.), G. Genimatas Hospital, 11527 Athens, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Tampourlou
authors.affiliation: Department of Endocrinology, Diabetes, and Metabolism (D.A.V., M.T., V.T., E.M., M.T., S.T.), Evangelismos Hospital, 10676 Athens, Greece; and Department of Endocrinology, Diabetes, and Metabolism (N.M., G.P.), G. Genimatas Hospital, 11527 Athens, Greece.
authors.forename: N
authors.initials: N
authors.lastname: Mazarakis
authors.affiliation: Department of Endocrinology, Diabetes, and Metabolism (D.A.V., M.T., V.T., E.M., M.T., S.T.), Evangelismos Hospital, 10676 Athens, Greece; and Department of Endocrinology, Diabetes, and Metabolism (N.M., G.P.), G. Genimatas Hospital, 11527 Athens, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Piaditis
authors.affiliation: Department of Endocrinology, Diabetes, and Metabolism (D.A.V., M.T., V.T., E.M., M.T., S.T.), Evangelismos Hospital, 10676 Athens, Greece; and Department of Endocrinology, Diabetes, and Metabolism (N.M., G.P.), G. Genimatas Hospital, 11527 Athens, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Tsagarakis
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000503:physiopathology; D000368:Aged; D003346:Corticotropin-Releasing Hormone; D003907:Dexamethasone; D005260:Female; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010901:Pituitary Function Tests; D010913:Pituitary-Adrenal System / Q000503:physiopathology*
chemical_list: D003907:Dexamethasone; D003346:Corticotropin-Releasing Hormone