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Extraction and Analysis of Cortisol from Human and Monkey Hair
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Autonomous cortisol secretion in adrenal incidentalomas.

Marta Araujo-Castro1, Miguel Antonio Sampedro Núñez2, Mónica Marazuela3

  • 1Department of Endocrinology, Hospital Universitario La Princesa, Instituto de Investigación Princesa, Madrid, Spain. martaazul.2a@hotmail.com.

Endocrine
|March 9, 2019
PubMed
Summary

Adrenal incidentalomas (AI) can have autonomous cortisol secretion (ACS), increasing risks for diabetes and cardiovascular disease. Early identification and management are crucial due to associated health complications.

Keywords:
Adrenal incidentalomasAutonomous cortisol secretionCushing's syndromeHypercortisolism

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Area of Science:

  • Endocrinology
  • Internal Medicine

Background:

  • Adrenal incidentalomas (AI) are common, found in 3-10% of the population.
  • Up to 20% of AI cases exhibit autonomous cortisol secretion (ACS), characterized by excess cortisol without overt Cushing's syndrome.
  • ACS is linked to significant health risks, including diabetes, obesity, hypertension, and cardiovascular events.

Purpose of the Study:

  • To provide a comprehensive review of autonomous cortisol secretion (ACS).
  • To offer a quick reference guide for diagnosing and managing AI with ACS.
  • To address the lack of consensus in ACS diagnosis and treatment.

Main Methods:

  • Review of existing literature on adrenal incidentalomas and autonomous cortisol secretion.
  • Analysis of diagnostic laboratory assays, including the dexamethasone suppression test.
  • Discussion of epidemiological data, clinical implications, and treatment strategies.

Main Results:

  • The dexamethasone suppression test is a common screening tool for ACS, but lacks a universally agreed-upon cutoff point.
  • Isolated low ACTH, low DHEA-S, or high urinary free cortisol have limited diagnostic value for ACS.
  • ACS is associated with increased risks of diabetes, obesity, hypertension, osteoporosis, cardiovascular events, and mortality.

Conclusions:

  • Accurate identification of ACS in adrenal incidentalomas is critical due to its significant health implications.
  • Further research and consensus are needed regarding optimal diagnostic criteria and management strategies for ACS.
  • This review serves as a guide for clinicians managing patients with AI and potential ACS.