Latent Autonomous Cortisol Secretion From Apparently Nonfunctioning Adrenal Tumor in Nonlateralized...

Area of Science:

• Endocrinology
• Nephrology
• Metabolic Disorders

Background:

• Adrenal tumors (ATs), even if nonfunctioning, can cause metabolic issues.
• Bilateral primary aldosteronism (PA) diagnosis via adrenal venous sampling (AVS) may involve ATs.
• The impact of apparently nonfunctioning ATs in PA requires further clarification.

Purpose of the Study:

• To investigate the influence of apparently nonfunctioning ATs in bilateral PA.
• To compare hormone levels and clinical complications between bilateral PA patients with and without ATs.

Main Methods:

• Retrospective analysis of 2814 PA patients from the Japan PA study.
• Division of bilateral PA cases (identified by AVS) into groups with and without ATs (based on CT scans).
• Exclusion of patients with cortisol >1.8 µg/dL post-1-mg dexamethasone suppression test (DST); comparison of clinical and biochemical data.

Main Results:

• 196 bilateral PA patients with ATs and 331 without were analyzed.
• Cases with ATs showed higher post-1-mg DST cortisol, diabetes mellitus, and proteinuria, but lower ACTH and plasma renin activity.
• Post-1-mg DST cortisol and plasma renin activity remained significantly different after adjustments; AT size correlated with post-1-mg DST cortisol and ACTH.

Conclusions:

• Apparently nonfunctioning ATs in bilateral PA may conceal autonomous cortisol secretion.
• This latent cortisol secretion can contribute to the development of diabetes mellitus and proteinuria.
• Further investigation into ATs in PA is warranted for metabolic disorder management.