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Predictive model for autonomous cortisol secretion development in non-functioning adrenal incidentalomas.

Marta Araujo-Castro1,2, Ana M García Cano3, Héctor F Escobar-Morreale4,5,6

  • 1Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal, Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain. marta.araujo@salud.madrid.org.

Hormones (Athens, Greece)
|October 24, 2022
PubMed
Summary
This summary is machine-generated.

A predictive model can identify patients with non-functioning adrenal incidentalomas (AIs) at low risk for developing autonomous cortisol secretion (ACS). Patients under 50 with unilateral AIs and low post-dexamethasone suppression test (DST) cortisol levels may not require follow-up.

Keywords:
Adrenal incidentalomasAutonomous cortisol secretionDexamethasone suppression test

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Area of Science:

  • Endocrinology
  • Oncology
  • Radiology

Background:

  • Adrenal incidentalomas (AIs) are common, and predicting autonomous cortisol secretion (ACS) is crucial for management.
  • Non-functioning AIs require careful follow-up to detect hormonal activity.

Purpose of the Study:

  • To develop a predictive model for stratifying patients with non-functioning AIs based on their risk of developing ACS.
  • To identify subgroups of patients who may not require intensive follow-up.

Main Methods:

  • Retrospective study of 331 patients with non-functioning AIs and at least 1 year of hormonal follow-up.
  • Multivariate Cox regression model incorporating clinical, biochemical, and radiological features.
  • Analysis of factors predicting ACS development, defined as post-dexamethasone suppression test (DST) serum cortisol > 1.8 µg/dL.

Main Results:

  • ACS developed in 73 patients over a median follow-up of 35.7 months.
  • The best predictive model included age, post-DST serum cortisol, and tumor bilaterality (AUC-ROC 0.70).
  • Patients <50 years old with unilateral AIs and post-DST cortisol < 0.45 µg/dL had the lowest ACS risk (2.42%). Baseline post-DST cortisol was the strongest predictor (HR 3.56 per µg/dL).

Conclusions:

  • A predictive model combining age, post-DST cortisol, and bilaterality accurately assesses ACS risk in non-functioning AIs.
  • Follow-up may be unnecessary for low-risk patients (<50 years, unilateral AI, post-DST cortisol < 0.45 µg/dL) after excluding malignancy.
  • Baseline post-DST cortisol is a key factor in predicting ACS development.