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.
| Title: | 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. |
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| Authors: | Theodoraki A; Department of Endocrinology, Royal Free Hampstead NHS Trust, London, United Kingdom. aikaterini.theodoraki@nhs.net; Khoo B; Hamda A; Schwappach A; Perera S; Vanderpump MP; Bouloux PM |
| Source: | Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme [Horm Metab Res] 2011 Dec; Vol. 43 (13), pp. 962-9. Date of Electronic Publication: 2011 Nov 02. |
| Publication Type: | Clinical Trial; Journal Article |
| Language: | English |
| Journal Info: | Publisher: Thieme Country of Publication: Germany NLM ID: 0177722 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1439-4286 (Electronic) Linking ISSN: 00185043 NLM ISO Abbreviation: Horm Metab Res Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Stuttgart, Thieme. |
| MeSH Terms: | Adrenal Gland Neoplasms/*drug therapy ; Dexamethasone/*administration & dosage; Aged ; Drug Administration Schedule ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies |
| 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.; (© Georg Thieme Verlag KG Stuttgart · New York.) |
| Substance Nomenclature: | 7S5I7G3JQL (Dexamethasone) |
| SCR Disease Name: | Adrenal incidentaloma |
| Entry Date(s): | Date Created: 20111104 Date Completed: 20120607 Latest Revision: 20161203 |
| Update Code: | 20260130 |
| DOI: | 10.1055/s-0031-1291249 |
| PMID: | 22048862 |
| Database: | MEDLINE |
Clinical Trial; Journal Article