Accuracy of several parameters of hypothalamic–pituitary–adrenal axis activity in predicting before surgery the metabolic effects of the removal of an adrenal incidentaloma
| Autor: | Bruno Ambrosi, Elisa Cairoli, Francesca Coletti, Antonio Stefano Salcuni, Claudia Battista, Valentina Morelli, Iacopo Chiodini, Laura Iorio, Paolo Beck-Peccoz, Alfredo Scillitani, Cristina Eller-Vainicher, Maura Arosio, Massimo Torlontano |
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| Rok vydání: | 2010 |
| Předmět: |
Adenoma
Adult Male Hypothalamo-Hypophyseal System medicine.medical_specialty Hydrocortisone Endocrinology Diabetes and Metabolism medicine.medical_treatment Adrenal Gland Neoplasm Adrenal Gland Neoplasms Pituitary-Adrenal System Context (language use) Sensitivity and Specificity Dexamethasone chemistry.chemical_compound Endocrinology Adrenocorticotropic Hormone Predictive Value of Tests Internal medicine medicine Humans Longitudinal Studies Adrenal incidentaloma Aged Retrospective Studies Incidental Findings business.industry Cholesterol Adrenalectomy General Medicine Middle Aged Surgery Blood pressure medicine.anatomical_structure chemistry Metabolic effects Female business Hypothalamic–pituitary–adrenal axis |
| Zdroj: | European Journal of Endocrinology. 163:925-935 |
| ISSN: | 1479-683X 0804-4643 |
| DOI: | 10.1530/eje-10-0602 |
| Popis: | ContextIt is unknown whether the metabolic effects of the removal of an adrenal incidentaloma (AI) can be predicted by the assessment of cortisol hypersecretion before surgery.ObjectiveTo evaluate the accuracy of several criteria of hypothalamic–pituitary–adrenal axis activity in predicting the metabolic outcome after adrenalectomy.DesignRetrospective longitudinal study.PatientsIn 55 surgically treated AI patients (Group 1) before surgery and in 53 nontreated AI patients (Group 2) at the baseline, urinary free cortisol (UFC), cortisol after 1 mg overnight dexamethasone-suppression test (1 mg-DST), ACTH, and midnight serum cortisol (MSC) were measured. In Groups 1 and 2, metabolic parameters were evaluated before and 29.6±13.8 months after surgery and at the baseline and after 35.2±10.9 months respectively.Main outcome measuresThe improvement/worsening of weight, blood pressure, glucose, and cholesterol levels (endpoints) was defined by the presence of a >5% weight decrease/increase and following the European Society of Cardiology or the ATP III criteria respectively. The accuracy of UFC, 1 mg-DST, ACTH, and MSC, singularly taken or in combination, in predicting the improvement/worsening of ≥2 endpoints was calculated.ResultsThe presence of ≥2 among UFC>70 μg/24 h (193 nmol/l), ACTH3.0 μg/dl (83 nmol/l) (UFC–ACTH–DST criterion) had the best accuracy in predicting the endpoints' improvement (sensitivity (SN) 65.2%, specificity (SP) 68.8%) after surgery. In the nontreated AI patients, this criterion predicted the worsening of ≥2 endpoints (SN 55.6%, SP 82.9%).ConclusionsThe UFC–ACTH–DST criterion seems to be the best for predicting the metabolic outcome in surgically treated AI patients. |
| Databáze: | OpenAIRE |
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