Outcomes in 125 Individuals with Adrenal Incidentalomas from a Single Centre. A Retrospective Assessment of the 1 mg Overnight and Low Dose Dexamethasone Suppression Tests

A. Theodoraki; B. Khoo; A. Hamda; A. Schwappach; S. Perera; M.P. J. Vanderpump; P. M. Bouloux

doi:10.1055/s-0031-1291249

Hormone and Metabolic Research, Table of Contents

Horm Metab Res 2011; 43(13): 962-969
DOI: 10.1055/s-0031-1291249

Humans, Clinical

Outcomes in 125 Individuals with Adrenal Incidentalomas from a Single Centre. A Retrospective Assessment of the 1 mg Overnight and Low Dose Dexamethasone Suppression Tests

A. Theodoraki

¹Department of Endocrinology, Royal Free Hampstead NHS Trust, London, United Kingdom

,

B. Khoo

¹Department of Endocrinology, Royal Free Hampstead NHS Trust, London, United Kingdom

,

A. Hamda

¹Department of Endocrinology, Royal Free Hampstead NHS Trust, London, United Kingdom

,

A. Schwappach

¹Department of Endocrinology, Royal Free Hampstead NHS Trust, London, United Kingdom

,

S. Perera

¹Department of Endocrinology, Royal Free Hampstead NHS Trust, London, United Kingdom

,

M.P. J. Vanderpump

¹Department of Endocrinology, Royal Free Hampstead NHS Trust, London, United Kingdom

,

P. M. Bouloux

¹Department of Endocrinology, Royal Free Hampstead NHS Trust, London, United Kingdom

› Author Affiliations

Abstract

Adrenal masses discovered incidentally during imaging studies – adrenal incidentalomas (AIs) – are common and prompt investigations to exclude secretory lesions and malignancy. Their best management strategy is unknown. Our objectives were to identify all outcomes of AI investigation in a UK centre and to assess the performance of the 2 mg low dose (LDDST) and 1 mg overnight dexamethasone (ODST) suppression tests in this setting.

Out of 125 patients referred to our centre between 2005 and 2009 with AIs, 16 (12.8%) were diagnosed with secretory adrenal adenomas. 24 patients (23%) failed to suppress on LDDST or ODST using a serum cortisol cut-off of 50 nmol/l for both tests; in 12 this was due to false positive results. 5 patients were diagnosed with adrenal Cushing’s syndrome and 7 with subclinical hypercortisolism. The use of a higher post LDDST (83 nmol/l) or ODST (138 nmol/l) cortisol cut-off would have resulted in missing 1 patient with Cushing’s syndrome and 4 with subclinical hypercortisolism or 2 patients with Cushing’s syndrome and 1 with subclinical hypercortisolism, respectively. In patients who had both tests, the ODST systematically resulted in higher post-test cortisol values compared with the LDDST. The adenoma diameter correlated with and was predictive of the post LDDST cortisol.

Our results indicate that altering the post dexamethasone cut-off in accordance to published guidelines changes the performance of the suppression tests. The ODST may result in higher post-test cortisol levels compared to LDDST when used in patients with AIs.

Key words

adrenal adenoma - Cushing’s syndrome - hypercortisolism

Full Text

References

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