Contralateral adrenal thinning as a distinctive feature of mild autonomous cortisol excess of the adrenal tumors

in European Journal of Endocrinology
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  • 1 Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea

Correspondence should be addressed to J H Kim; Email: jhkxingfu@gmail.com
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Objective:

To identify radiologic features that correlate with mild autonomous cortisol excess using planar and volumetric analysis.

Design:

Cross-sectional study.

Methods:

In the study, 64 patients with overt Cushing syndrome (CS), 59 patients with mild autonomous cortisol excess (MACE), and 64 patients with nonfunctioning adrenal tumors (NFAT) with evaluable CT scans were included. Patients with NFAT and MACE were BMI-matched with those with overt CS. Planar and volumetric analyses of CT scans were performed in DICOM images using OsiriX software.

Results:

The mean age was 56.6 ± 1.01 years, and 123 patients (65.1%) were female. In the order of NFAT, MACE, and overt CS, the diameters and volumes of the adenoma increased, while limb widths and volumes of the contralateral adrenal gland decreased. Patients with MACE or overt CS were more likely to have osteoporosis than those with NFAT (P = 0.006), and patients with overt CS were more likely to experience a fragility fracture than those with NFAT or MACE (P = 0.002). Among radiologic features, the limb width of the contralateral adrenal gland correlated with the cortisol level after overnight dexamethasone suppression test (r = −0.583, P < 0.001).

Conclusions:

The study showed that the contralateral adrenal limb thinning was a distinctive radiologic feature of autonomous cortisol excess in the planar and volumetric analysis.

 

     European Society of Endocrinology

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  • 1

    Young WF, Jr. Clinical practice. The incidentally discovered adrenal mass. New England Journal of Medicine 2007 356 601610. PubMed PMID: 17287480. (https://doi.org/10.1056/NEJMcp065470)

    • Search Google Scholar
    • Export Citation
  • 2

    Davenport C, Liew A, Doherty B, Win HHN, Misran H, Hanna S, Kealy D, Al-Nooh F, Agha A & Thompson CJ, The prevalence of adrenal incidentaloma in routine clinical practice. Endocrine 2011 40 8083. (https://doi.org/10.1007/s12020-011-9445-6)

    • Search Google Scholar
    • Export Citation
  • 3

    Kloos RT, Gross MD, Francis IR, Korobkin M, Shapiro B. Incidentally discovered adrenal masses. Endocrine Reviews 1995 16 460484. PubMed PMID: 8521790. Epub 1995/08/01. (https://doi.org/10.1210/edrv-16-4-460)

    • Search Google Scholar
    • Export Citation
  • 4

    Fassnacht M, Arlt W, Bancos I, Dralle H, Newell-Price J, Sahdev A, Tabarin A, Terzolo M, Tsagarakis S, Dekkers OM. Management of adrenal incidentalomas: European society of endocrinology clinical practice guideline in collaboration with the European network for the study of adrenal tumors. European Journal of Endocrinology 2016 175 G1G34. (https://doi.org/10.1530/EJE-16-0467)

    • Search Google Scholar
    • Export Citation
  • 5

    Mantero F, Terzolo M, Arnaldi G, Osella G, Masini AM, Alı̀ A, Giovagnetti M, Opocher G, Angeli A. A survey on adrenal incidentaloma in Italy. Study group on adrenal tumors of the Italian society of endocrinology. Journal of Clinical Endocrinology & Metabolism 2000 85 637644. (https://doi.org/10.1210/jcem.85.2.6372)

    • Search Google Scholar
    • Export Citation
  • 6

    Di Dalmazi G, Vicennati V, Garelli S, Casadio E, Rinaldi E, Giampalma E, Mosconi C, Golfieri R, Paccapelo A & Pagotto U, Cardiovascular events and mortality in patients with adrenal incidentalomas that are either non-secreting or associated with intermediate phenotype or subclinical Cushing’s syndrome: a 15-year retrospective study. Lancet Diabetes Endocrinology 2014 2 396405. (https://doi.org/10.1016/S2213-8587(13)70211-0)

    • Search Google Scholar
    • Export Citation
  • 7

    Lee JM, Kim MK, Ko SH, Koh JM, Kim BY, Kim SW, Kim SK, Kim HJ, Ryu OH & Park J, Clinical guidelines for the management of adrenal incidentaloma. Endocrinology & Metabolism 2017 32 200218. (https://doi.org/10.3803/EnM.2017.32.2.200)

    • Search Google Scholar
    • Export Citation
  • 8

    Terzolo M, Bovio S, Reimondo G, Pia A, Osella G, Borretta G, Angeli A. Subclinical Cushing’s syndrome in adrenal incidentalomas. Endocrinology & Metabolism Clinics of North America 2005 34 423439. PubMed PMID: 15850851. Epub 2005/04/27. (https://doi.org/10.1016/j.ecl.2005.01.008)

    • Search Google Scholar
    • Export Citation
  • 9

    Hong AR, Kim JH, Park KS, Kim KY, Lee JH, Kong SH, Lee SY, Shin CS, Kim SW, Kim SY. Optimal follow-up strategies for adrenal incidentalomas: reappraisal of the 2016 ESE-ENSAT guidelines in real clinical practice. European Journal of Endocrinology 2017 177 475483. PubMed PMID: 28870984. Epub 2017/09/06. (https://doi.org/10.1530/EJE-17-0372)

    • Search Google Scholar
    • Export Citation
  • 10

    Debono M, Bradburn M, Bull M, Harrison B, Ross RJ, Newell-Price J. Cortisol as a marker for increased mortality in patients with incidental adrenocortical adenomas. Journal of Clinical Endocrinology & Metabolism 2014 99 44624470. PubMed PMID: 25238207. Pubmed Central PMCID: PMC4255126. Epub 2014/09/23. (https://doi.org/10.1210/jc.2014-3007)

    • Search Google Scholar
    • Export Citation
  • 11

    Morelli V, Reimondo G, Giordano R, Della Casa S, Policola C, Palmieri S, Salcuni AS, Dolci A, Mendola M, Arosio M, Long-term follow-up in adrenal incidentalomas: an Italian multicenter study. Journal of Clinical Endocrinology & Metabolism 2014 99 827834. PubMed PMID: 24423350. Epub 2014/01/16. (https://doi.org/10.1210/jc.2013-3527)

    • Search Google Scholar
    • Export Citation
  • 12

    Kyle LH, Meyer RJ, Canary JJ. Mechanism of adrenal atrophy in Cushing’s syndrome due to adrenal tumor. New England Journal of Medicine 1957 257 5761. (https://doi.org/10.1056/NEJM195707112570203)

    • Search Google Scholar
    • Export Citation
  • 13

    Park SY, Oh YT, Jung DC, Rhee Y. Prediction of adrenal adenomas with hypercortisolism by using adrenal computed tomography: emphasis on contralateral adrenal thinning. Journal of Computer Assisted Tomography 2015 39 741746. (https://doi.org/10.1097/RCT.0000000000000269)

    • Search Google Scholar
    • Export Citation
  • 14

    Serifoglu I, Oz II, Bilici M. The adrenal gland volume measurements in manifestation of the metabolic status in type-2 diabetes mellitus patients. International Journal of Endocrinology 2016 2016 7195849. (https://doi.org/10.1155/2016/7195849)

    • Search Google Scholar
    • Export Citation
  • 15

    Sugiura M, Imamura Y, Kawamura K, Yamamoto S, Sazuka T, Nakamura K, Sakamoto S, Nagano H, Koide H, Tanaka T, Contralateral adrenal width predicts the duration of prolonged post‐surgical steroid replacement for subclinical Cushing syndrome. International Journal of Urology 2018 25 583588. (https://doi.org/10.1111/iju.13566)

    • Search Google Scholar
    • Export Citation
  • 16

    Amsterdam JD, Marinelli DL, Arger P, Winokur A. Assessment of adrenal gland volume by computed tomography in depressed patients and healthy volunteers: a pilot study. Psychiatry Research 1987 21 189197. (https://doi.org/10.1016/0165-1781(87)90022-9)

    • Search Google Scholar
    • Export Citation
  • 17

    American Diabetes Association. Classification and diagnosis of diabetes: standards of medical care in Diabetes—2020. Diabetes Care 2020 43 (Supplement 1) S14S31. (https://doi.org/10.2337/dc20-S002)

    • Search Google Scholar
    • Export Citation
  • 18

    World Health Organization. Assessment of Fracture Risk and Its Application to Screening for Postmenopausal Osteoporosis: Report of a WHO Study Group [Meeting Held in Rome from 22 to 25 June 1992]. World Health Organization, 1994.

    • Search Google Scholar
    • Export Citation
  • 19

    Vincent JM, Morrison ID, Armstrong P, Reznek RH. The size of normal adrenal glands on computed tomography. Clinical Radiology 1994 49 453455. (https://doi.org/10.1016/s0009-9260(05)81739-8)

    • Search Google Scholar
    • Export Citation
  • 20

    Di Dalmazi G, Vicennati V, Rinaldi E, Morselli-Labate AM, Giampalma E, Mosconi C, Pagotto U, Pasquali R. Progressively increased patterns of subclinical cortisol hypersecretion in adrenal incidentalomas differently predict major metabolic and cardiovascular outcomes: a large cross-sectional study. European Journal of Endocrinology 2012 166 669677. (https://doi.org/10.1530/EJE-11-1039)

    • Search Google Scholar
    • Export Citation
  • 21

    Terzolo M, Stigliano A, Chiodini I, Loli P, Furlani L, Arnaldi G, Reimondo G, Pia A, Toscano V & Zini M, AME position statement on adrenal incidentaloma. European Journal of Endocrinology 2011 164 851870. (https://doi.org/10.1530/EJE-10-1147)

    • Search Google Scholar
    • Export Citation
  • 22

    Nieman LK, Biller BM, Findling JW, Newell-Price J, Savage MO, Stewart PM, Montori VM. The diagnosis of Cushing’s syndrome: an endocrine society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism 2008 93 15261540. (https://doi.org/10.1210/jc.2008-0125)

    • Search Google Scholar
    • Export Citation
  • 23

    Reimondo G, Allasino B, Bovio S, Saba L, Ardito A, Angeli A, Terzolo M. Pros and cons of dexamethasone suppression test for screening of subclinical Cushing’s syndrome in patients with adrenal incidentalomas. Journal of Endocrinological Investigation 2011 34 e1e5. (https://doi.org/10.1007/BF03346701)

    • Search Google Scholar
    • Export Citation
  • 24

    Baid SK, Rubino D, Sinaii N, Ramsey S, Frank A, Nieman LK. Specificity of screening tests for Cushing’s syndrome in an overweight and obese population. Journal of Clinical Endocrinology & Metabolism 2009 94 38573864. (https://doi.org/10.1210/jc.2008-2766)

    • Search Google Scholar
    • Export Citation
  • 25

    Hong AR, Kim JH, Hong ES, Kim IK, Park KS, Ahn CH, Kim SW, Shin CS, Kim SY. Limited diagnostic utility of plasma adrenocorticotropic hormone for differentiation between adrenal Cushing syndrome and Cushing disease. Endocrinology & Metabolism 2015 30 297304. (https://doi.org/10.3803/EnM.2015.30.3.297)

    • Search Google Scholar
    • Export Citation
  • 26

    Terzolo M, Pia A, Reimondo G. Subclinical Cushing’s syndrome: definition and management. Clinical Endocrinology 2012 76 1218. (https://doi.org/10.1111/j.1365-2265.2011.04253.x)

    • Search Google Scholar
    • Export Citation
  • 27

    Schneller J, Reiser M, Beuschlein F, Osswald A, Pallauf A, Riester A, Tietze JK, Reincke M, Degenhart C. Linear and volumetric evaluation of the adrenal gland—MDCT-based measurements of the adrenals. Academic Radiology 2014 21 14651474. (https://doi.org/10.1016/j.acra.2014.06.008)

    • Search Google Scholar
    • Export Citation
  • 28

    Giraldi FP, Ambrogio AG. Variability in laboratory parameters used for management of Cushing’s syndrome. Endocrine 2015 50 580589. (https://doi.org/10.1007/s12020-015-0676-9)

    • Search Google Scholar
    • Export Citation
  • 29

    Giraldi FP, Saccani A, Cavagnini F. Assessment of ACTH assay variability: a multicenter study. European Journal of Endocrinology 2011 164 505512. (https://doi.org/10.1530/EJE-10-0962)

    • Search Google Scholar
    • Export Citation
  • 30

    Carnes M, Goodman BM, Lent SJ, Vo H, Jaeckels R. Coincident plasma ACTH and corticosterone time series: comparisons between young and old rats. Experimental Gerontology 1994 29 625643. (https://doi.org/10.1016/0531-5565(94)90075-2)

    • Search Google Scholar
    • Export Citation
  • 31

    Kim BY, Won JC, Lee JH, Kim HS, Park JH, Ha KH, Won KC, Kim DJ, Park KS. Diabetes fact sheets in Korea, 2018: an appraisal of current status. Diabetes & Metabolism Journal 2019 43 487494. (https://doi.org/10.4093/dmj.2019.0067)

    • Search Google Scholar
    • Export Citation
  • 32

    Reimondo G, Castellano E, Grosso M, Priotto R, Puglisi S, Pia A, Pellegrino M, Borretta G, Terzolo M. Adrenal incidentalomas are tied to increased risk of diabetes: findings from a prospective study. Journal of Clinical Endocrinology & Metabolism 2020 105 e973e981. (https://doi.org/10.1210/clinem/dgz284)

    • Search Google Scholar
    • Export Citation
  • 33

    Terzolo M, Pia A, Alì A, Osella G, Reimondo G, Bovio S, Daffara F, Procopio M, Paccotti P & Borretta G, Adrenal incidentaloma: a new cause of the metabolic syndrome? Journal of Clinical Endocrinology & Metabolism 2002 87 9981003. (https://doi.org/10.1210/jcem.87.3.8277)

    • Search Google Scholar
    • Export Citation
  • 34

    Reincke M, Fassnacht M, Väth S, Mora P, Allolio B. Adrenal incidentalomas: a manifestation of the metabolic syndrome? Endocrine Research 1996 22 757761. (https://doi.org/10.1080/07435809609043773)

    • Search Google Scholar
    • Export Citation
  • 35

    Elhassan YS, Alahdab F, Prete A, Delivanis DA, Khanna A, Prokop L, Murad MH, O’Reilly MW, Arlt W, Bancos I. Natural history of adrenal incidentalomas with and without mild autonomous cortisol excess: a systematic review and meta-analysis. Annals of Internal Medicine 2019 171 107116. (https://doi.org/10.7326/M18-3630)

    • Search Google Scholar
    • Export Citation
  • 36

    Mazziotti G, Gazzaruso C, Giustina A. Diabetes in Cushing syndrome: basic and clinical aspects. Trends in Endocrinology & Metabolism 2011 22 499506. (https://doi.org/10.1016/j.tem.2011.09.001)

    • Search Google Scholar
    • Export Citation
  • 37

    Rubin RT, Phillips JJ. Adrenal gland volume determination by computed tomography and magnetic resonance imaging in normal subjects. Investigative Radiology 1991 26 465469. (https://doi.org/10.1097/00004424-199105000-00015)

    • Search Google Scholar
    • Export Citation