title: The activity of 11β-hydroxysteroid dehydrogenase type 2 enzyme and cortisol secretion in patients with adrenal incidentalomas.
abstract: In adrenal incidentaloma (AI) patients, beside the cortisol secretion, a different 11β-hydroxysteroid dehydrogenase type 2 (HSD11B2) activity, measurable by 24-h urinary cortisol/cortisone ratio (R-UFF/UFE) (the higher R-UFF/UFE the lower HSD11B2 activity), could influence the occurrence of the subclinical hypercortisolism (SH)-related complications (hypertension, type 2 diabetes, obesity). We evaluated whether in AI patients, UFF levels are associated to UFE levels, and the HSD11B2 activity to the complications presence. In 156 AI patients (93F, age 65.2 ± 9.5 years), the following were measured: serum cortisol after 1 mg-dexamethasone test (1 mg-DST), ACTH, UFF, UFE levels, and R-UFF/UFE (by liquid chromatography-tandem mass spectrometry), the latter was also evaluated in 63 matched-controls. We diagnosed SH (n = 22) in the presence of ≥2 among ACTH <2.2 pmol/L, increased UFF levels, and 1 mg-DST >83 nmol/L. Patients showed higher UFF levels and R-UFF/UFE than controls (75.9 ± 43.1 vs 54.4 ± 22.9 nmol/24 h and 0.26 ± 0.12 vs 0.20 ± 0.07, p < 0.005, respectively) but comparable UFE levels (291 ± 91.1 vs 268 ± 61.5, p = 0.069). The R-UFF/UFE was higher in patients with high (h-UFF, n = 28, 0.41 ± 0.20) than in those with normal (n-UFF, 0.22 ± 0.10, p < 0.005) UFF levels and in patients with SH than in those without SH (0.30 ± 0.12 vs 0.25 ± 0.12, p = 0.04). UFF levels were associated with R-UFF/UFE (r = 0.849, p < 0.001) in n-UFF, but not in h-UFF patients. Among h-UFF patients, the complications prevalence was not associated with R-UFF/UFE values. In AI patients, the UFF increase is not associated with a UFE increase. The HSD11B2 activity is inversely associated with UFF levels in n-UFF patients but not in h-UFF patients, and it is not associated with the SH complications.
authors.affiliation: Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Morelli
authors.affiliation: Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Polledri
authors.affiliation: Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Mercadante
authors.affiliation: Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy.
authors.forename: Volha
authors.initials: V
authors.lastname: Zhukouskaya
authors.affiliation: Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Palmieri
authors.affiliation: Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Beck-Peccoz
authors.affiliation: Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Spada
authors.affiliation: Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Fustinoni
authors.affiliation: Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy. iacopo.chiodini@policlinico.mi.it.|Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Padiglione Granelli, Via Francesco Sforza 35, 20122, Milan, Italy. iacopo.chiodini@policlinico.mi.it.
authors.forename: Iacopo
authors.initials: I
authors.lastname: Chiodini
mesh_terms: D043209:11-beta-Hydroxysteroid Dehydrogenase Type 2 / Q000378:metabolism*; D000310:Adrenal Gland Neoplasms / Q000378:metabolism*; D000368:Aged; D003348:Cortisone / Q000378:metabolism*; D003907:Dexamethasone; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D053719:Tandem Mass Spectrometry
chemical_list: D003907:Dexamethasone; D043209:11-beta-Hydroxysteroid Dehydrogenase Type 2; D003348:Cortisone; D006854:Hydrocortisone
keywords: Adrenal incidentalomas; Subclinical hypercortisolism; Tandem mass spectrometry; Urinary free cortisol