Accuracy of the dexamethasone suppression test for the prediction of autonomous cortisol secretion-related comorbidities in adrenal incidentalomas

• Published in: Hormones (Athens, Greece) Vol. 20; no. 4; pp. 735 - 744
• Main Authors: Araujo-Castro, Marta, Parra Ramírez, Paola, Robles Lázaro, Cristina, García Centeno, Rogelio, Gracia Gimeno, Paola, Fernández-Ladreda, Mariana Tomé, Sampedro Núñez, Miguel Antonio, Marazuela, Mónica, Escobar-Morreale, Héctor F., Valderrabano, Pablo
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.12.2021
• Subjects: Adrenal Gland Neoplasms - diagnosis; Adrenal Gland Neoplasms - epidemiology; Dexamethasone - analysis; Dexamethasone - pharmacology; Endocrinology; Humans; Hydrocortisone - analysis; Hydrocortisone - metabolism; Hypertension - diagnosis; Hypertension - epidemiology; Medicine; Medicine & Public Health; Metabolic Diseases; Original Article; Prevalence; Retrospective Studies; Syndrome; Adrenal incidentalomas; Dexamethasone suppression test; Non-functioning adrenal incidentalomas; Autonomous cortisol secretion; Autonomous cortisol secretion-related comorbidities
• ISSN: 1109-3099; 2520-8721
• DOI: 10.1007/s42000-021-00308-z

Purpose The aim of this study was to evaluate the diagnostic accuracy of the 1 mg dexamethasone suppression test (DST) for the prediction of autonomous cortisol secretion (ACS)-related comorbidities in patients with adrenal incidentalomas (AIs). Methods This was a retrospective multicenter study. We recruited patients with AI/s ≥ 1 cm, excluding those who, during the study, were found during the extension study of an extra-adrenal cancer, with a known diagnosis of hereditary syndromes characterized by adrenal tumors, those presenting with overt hormonal excess syndromes, and those in whom the DST results were missing. Results A total of 823 patients met the inclusion criteria. Based on the 1.8, 3.0, and 5.0 µg/dl post-DST cortisol thresholds, the prevalence of ACS was 33.5%, 13.7%, and 5.6%, respectively. The prevalence of hypertension (OR = 1.8, 95% CI = 1.3–2.4), diabetes (OR = 1.6, 95% CI = 1.2–2.2), and dyslipidemia (OR = 1.4, 95% CI = 1.0–1.9) was higher with cortisol post-DST ≥ 1.8 µg/dl; the prevalence of hypertension (OR = 2.1, 95% CI = 1.4–3.3) and diabetes (OR = 1.7, 95% CI = 1.1–2.6) was higher with values ≥ 3.0 µg/dl; and the prevalence of hypertension (OR = 2.0, 95% CI = 1.0–3.7) was higher with levels ≥ 5.0 µg/dl. However, the diagnostic accuracy of the DST for the prediction of cardiometabolic comorbidities in patients with AIs was poor, with areas under the ROC curve < 0.61. Conclusions The DST is a poor predictor of cardiometabolic comorbidities in patients with AIs regardless of the cortisol cut-off values applied. This finding suggests that the diagnosis of ACS should not be based solely on the results of the DST. Other clinical, metabolic, or imaging markers showing a better performance for the prediction of the development and progression of cardiometabolic comorbidities in AIs need to be identified.