Adrenal Incidentaloma, Subclinical Hypercortisolism
Conditions
Keywords
serum dehydroepiandrosterone sulfate, adrenocorticotropic hormone, surgical management, conservative management
Brief summary
The purpose of this study is to evaluate the serum dehydroepiandrosterone sulfate in subclinical hypercortisolism
Detailed description
In the past few years, with the widespread use of chest and abdominal imaging, the prevalence of adrenal incidentaloma (AIs) has been increasing and now approaches the 8.7% incidence reported in autopsy series. subclinical hypercortisolism (SH) is noted in up to 30% of patients with adrenal incidentalomas. Several groups have reported adverse clinical sequelae in individuals with SH, with recent studies highlighting an increase in cardiovascular morbidity and mortality compared to the general population. Accurate exclusion or confirmation of a diagnosis of SH is therefore a key step in the investigation and management of patients with AIs. Suppressed adrenocorticotropic hormone (ACTH) and low dehydroepiandrosterone sulfate (DHEAS) levels are frequently found in SH patients. Present study added new evidence for the limitations of ACTH and confirmed the usefulness of DHEAS for the detection of SH especially with unsuppressed ACTH in AI patients. On one hand, in the cross-sectional study, biometric measurements and sex hormones (including DHEAS, 24h-UFC, ACTH and cortisol) are analysed to explore the differences among SH patients, and nonfunctional adrenal adenoma patients. One the other hand, in the longitudinal study, changes in DHEAS, ACTH and cortisol in SH with surgical management and SH with conservative management both at baseline and different follow-up months after their different treatment management are collected to explore the changes of DHEAS and ACTH of SH patients.
Interventions
DIAGNOSTIC_TESTexperimental group
DHEAS.24h-UFC,ACTH and cortisol are measured in the experimental group
Sponsors
The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
Yes
Inclusion criteria
* patients with adrenal accidental tumor (diameter \> 1cm) found by physical examination or imaging examination due to non-adrenal diseases
Exclusion criteria
* concomitant use of drugs influencing glucocorticoid metabolism or secretion * major psychiatric illness or history of excess alcohol intake * overt clinical features of hypercortisolism * clinical and endocrine function evaluation (surgery patients at the same time reference to postoperative pathology) revealed primary aldosteronism, pheochromocytoma, adrenocortical carcinoma, adrenal metastasis of cancer, myelolipoma; oncocytoma, congenital adrenal cortex hyperplasia and ganglion cells neuroma/paraganglioma, schwannoma, adrenal hematoma and uncertain diagnosis) * non-adenoma lesions such as cysts and hemorrhage * The pregnancy * Patients with severe underlying diseases (such as liver and kidney failure, acute severe infection, etc.) that may affect the function of the hypothalamus-pituitary-adrenal axis (HPA axis)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| dexamethasone suppression test | 2 day | Dexamethasone 1mg (0.75mg/ tablet, 1.5 tablets) was taken orally at 24:00 midnight, and plasma ACTH in pmol/L and serum cortisol in cortisol levels were measured by blood sample at 8:00 the next day |
| The gender and age of the participants | 1 day | age in years and sex (female or male) of patients |
| Participant's weight and height | 1 day | BMI(body mess index) in kg/m\^2= (weight in kg) /(height in m)\^2 |
| the diurnal rhythm of ACTH | 2 day | plasma ACTH in pmol/L at 8:00 am, 16:00 pm and 24:00 midnight |
| the the diurnal rhythm of cortisol | 2 day | serum cortisol in nmol/L at 8:00 am, 16:00 pm and 24:00 midnight measured on the same day as plasma ACTH |
| Patients' baseline DHEAS level | 1 day | serum DHEAS in ug/dL |
| CT imaging of adrenal tumor | 1 day | diameter in cm of adrenal adenoma |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| the changes of DHEAS after conservative management | 12 months after the conservative management (for subclinical hypercortisolism with conservative management) | DHEAS in ug/dL |
| the changes of ACTH after surgical management | 1,3,6 and12 months after the surgical management (for subclinical hypercortisolism with surgical managment) | ACTH in pmol/L |
| the changes of DHEAS after surgical management | 1,3,6 and12 months after the surgical management (for subclinical hypercortisolism with surgical managment) | DHEAS in ug/dL |
| the changes of ACTH after conservative management | 12 months after the conservative management (for subclinical hypercortisolism with conservative management) | ACTH in pmol/L |
| the changes of cortisol after conservative management | 12 months after the conservative management (for subclinical hypercortisolism with conservative management) | cortisol in nmol/L |
| the changes of cortisol after surgical management | 1,3,6 and12 months after the surgical management (for subclinical hypercortisolism with surgical managment) | cortisol in nmol/L |
Countries
China
Contacts
Primary ContactDalong Zhu, MD,PhD
Outcome results
None listed