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Updated: Apr 7, 2026
A Novel Method: Super-selective Adrenal Venous Sampling
Published on: September 15, 2017
Abnormal Responsiveness to Dexamethasone-Suppressed CRH Test in Patients With Bilateral Adrenal Incidentalomas
D A Vassiliadi1, M Tzanela1, V Tsatlidis1
1Department of Endocrinology, Diabetes, and Metabolism (D.A.V., M.T., V.T., E.M., M.T., S.T.), Evangelismos Hospital, 10676 Athens, Greece; and Department of Endocrinology, Diabetes, and Metabolism (N.M., G.P.), G. Genimatas Hospital, 11527 Athens, Greece.
Context:
The bilateral formation of nodules indicates that the pathogenesis of bilateral adrenal incidentalomas (AI) may differ from that of unilateral AI. A possible role of hypothalamo-pituitary-adrenal (HPA) axis dysregulation in their formation has not been investigated.
Objective:
The objective of the study was to evaluate the presence of altered feedback regulation of HPA axis in patients with bilateral AI.
Design:
The dexamethasone (DEX) suppression-CRH test was used to assess ACTH and cortisol responses in controls and patients with unilateral and bilateral AI.
Setting:
The study was conducted at endocrine departments of two tertiary centers.
Patients:
We studied 24 controls and 39 patients with unilateral and 46 with bilateral AI.
Interventions:
All subjects underwent standard low-dose dexamethasone suppression followed by iv bolus administration of human CRH (100 μg).
Results:
Bilateral AI had higher levels of ACTH and cortisol after the DEX-CRH challenge compared with both controls (P < .01 for ACTH and P < .001 for cortisol) and unilateral AI (P < .01 for ACTH and cortisol). A positive response, defined as peak ACTH greater than 10 pg/mL at 15 and/or 30 minutes followed by a significant rise in cortisol levels, was noted in 41.3% of bilateral vs 2.6% in unilateral AI (P < .001). Bilateral responders did not differ from nonresponders in demographic or hormonal characteristics, but they had larger total adrenal size compared with nonresponders.
Conclusions:
A significant proportion of patients with bilateral AI demonstrate positive responses to the DEX-CRH test compared with unilateral AI, providing ground for potential involvement of HPA axis dysregulation in the pathogenesis, in at least a subgroup, of bilateral AI patients.
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