Autonomous cortisol secretion in adrenal incidentalomas
Adrenal incidentalomas (AI) are one of the most frequent reasons for consultation in Endocrinology, as they are present in 3–10% of the general population. Up to 20% of them may have autonomous cortisol secretion (ACS), a term that refers to AI carriers with biochemical evidence of excess cortisol,...
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Published in | Endocrine Vol. 64; no. 1; pp. 1 - 13 |
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Main Authors | , , |
Format | Journal Article |
Language | English |
Published |
New York
Springer US
01.04.2019
Springer Nature B.V |
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Abstract | Adrenal incidentalomas (AI) are one of the most frequent reasons for consultation in Endocrinology, as they are present in 3–10% of the general population. Up to 20% of them may have autonomous cortisol secretion (ACS), a term that refers to AI carriers with biochemical evidence of excess cortisol, but without the “specific” clinical signs of Cushing’s syndrome. As ACS is associated with an increased risk of diabetes, obesity, high blood pressure (HBP), osteoporosis, cardiovascular events, and global mortality; its correct identification is of great importance. There are different laboratory assays to detect ACS, but all of them have some limitations. The dexamethasone suppression test is the most accepted for screening. However, there is no consensus on the cutoff point that should be used. Low levels of ACTH and DHEA-S and high urinary free cortisol are also associated with ACS, but in isolation they are of little value to establish the diagnosis. Considering its clinical implications and the lack of consensus in the diagnosis and in which is the most appropriate management of these patients, this review offers a quick reference guide of ACS, presenting an exhaustive review of the topic: its definition, epidemiology, diagnosis, clinical implications, treatment, and follow-up. |
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AbstractList | Adrenal incidentalomas (AI) are one of the most frequent reasons for consultation in Endocrinology, as they are present in 3–10% of the general population. Up to 20% of them may have autonomous cortisol secretion (ACS), a term that refers to AI carriers with biochemical evidence of excess cortisol, but without the “specific” clinical signs of Cushing’s syndrome. As ACS is associated with an increased risk of diabetes, obesity, high blood pressure (HBP), osteoporosis, cardiovascular events, and global mortality; its correct identification is of great importance. There are different laboratory assays to detect ACS, but all of them have some limitations. The dexamethasone suppression test is the most accepted for screening. However, there is no consensus on the cutoff point that should be used. Low levels of ACTH and DHEA-S and high urinary free cortisol are also associated with ACS, but in isolation they are of little value to establish the diagnosis. Considering its clinical implications and the lack of consensus in the diagnosis and in which is the most appropriate management of these patients, this review offers a quick reference guide of ACS, presenting an exhaustive review of the topic: its definition, epidemiology, diagnosis, clinical implications, treatment, and follow-up. |
Author | Sampedro Núñez, Miguel Antonio Marazuela, Mónica Araujo-Castro, Marta |
Author_xml | – sequence: 1 givenname: Marta orcidid: 0000-0002-0519-0072 surname: Araujo-Castro fullname: Araujo-Castro, Marta email: martaazul.2a@hotmail.com organization: Department of Endocrinology, Hospital Universitario La Princesa, Instituto de Investigación Princesa – sequence: 2 givenname: Miguel Antonio surname: Sampedro Núñez fullname: Sampedro Núñez, Miguel Antonio email: msampeter@gmail.com organization: Department of Endocrinology, Hospital Universitario La Princesa, Instituto de Investigación Princesa – sequence: 3 givenname: Mónica orcidid: 0000-0003-1158-9618 surname: Marazuela fullname: Marazuela, Mónica email: monicamarazuela@salud.madrid.org organization: Department of Endocrinology, Hospital Universitario La Princesa, Instituto de Investigación Princesa |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/30847651$$D View this record in MEDLINE/PubMed |
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Snippet | Adrenal incidentalomas (AI) are one of the most frequent reasons for consultation in Endocrinology, as they are present in 3–10% of the general population. Up... Adrenal incidentalomas (AI) are one of the most frequent reasons for consultation in Endocrinology, as they are present in 3-10% of the general population. Up... |
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SubjectTerms | Adrenal Gland Neoplasms - blood Adrenal Gland Neoplasms - diagnosis Adrenal glands Adrenocorticotropic hormone Blood pressure Cardiovascular diseases Cushing syndrome Cushing Syndrome - blood Cushing Syndrome - diagnosis Dehydroepiandrosterone Dexamethasone Diabetes Diabetes mellitus Diagnosis Endocrinology Epidemiology Hormones Humanities and Social Sciences Humans Hydrocortisone - blood Hypertension Incidental Findings Internal Medicine Medicine Medicine & Public Health multidisciplinary Nervous system diseases Osteoporosis Pituitary Review Science Secretion |
Title | Autonomous cortisol secretion in adrenal incidentalomas |
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