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[Autonomous cortisol secretion : Laboratory artifact or disease?]

Anna Riester1, Felix Beuschlein2,3

  • 1Medizinische Klinik und Poliklinik IV, LMU Klinikum, Ziemssenstr. 1, 80336, München, Deutschland. anna.riester@med.uni-muenchen.de.

Der Internist
|October 28, 2021
PubMed
Summary

Autonomous cortisol secretion, diagnosed via a dexamethasone suppression test in adrenal incidentaloma patients, is linked to higher mortality and comorbidities. Adrenalectomy is a potential treatment considered by multidisciplinary teams.

Keywords:
Adrenal adenomaAdrenal incidentalomaCushing syndromeDexamethasone suppression testHypercortisolism

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Area of Science:

  • Endocrinology
  • Oncology

Background:

  • Autonomous cortisol secretion (ACS) was first defined in the 2016 European Guideline for adrenal incidentalomas.
  • ACS involves abnormal cortisol secretion detected by a pathological 1-mg dexamethasone suppression test.

Purpose of the Study:

  • To review current knowledge on ACS diagnosis, epidemiology, comorbidities, mortality, and treatment.
  • To compare ACS with non-hormone-producing adenomas.
  • To provide clinical practice recommendations based on European guidelines.

Main Methods:

  • Systematic analysis of clinical studies.
  • Discussion of foundational literature and expert opinions.

Main Results:

  • ACS is associated with increased mortality and morbidity.
  • Key comorbidities include hypertension, type II diabetes mellitus, dyslipidemia, and obesity.
  • Patients lack overt Cushing's syndrome symptoms.

Conclusions:

  • Adrenalectomy is the sole specific therapeutic option for ACS.
  • Treatment decisions should be made by an interdisciplinary tumor board.
  • Early diagnosis and management are crucial for improving patient outcomes.