Korean J Urol.  2012 Jun;53(6):414-418.

Clinical Usefulness of Corticotropin Releasing Hormone Testing in Subclinical Cushing's Syndrome for Predicting Cortisol Replacement after Adrenalectomy

Affiliations
  • 1Department of Urology, Teikyo University School of Medicine, Tokyo, Japan. shorie@med.teikyo-u.ac.jp

Abstract

PURPOSE
The purpose of this study was to investigate the clinical and hormonal features of patients with incidentally discovered adrenal adenomas in relation to corticotropin releasing hormone (CRH) testing and the clinical outcome of adrenalectomy.
MATERIALS AND METHODS
Twenty-three consecutive patients with incidentally detected adrenal adenomas were included in this retrospective study. All the patients underwent abdominal computed tomography scans and hormonal assays, including assessment of circadian rhythms of plasma cortisol and corticotropin (adrenocorticotropic hormone, ACTH), a corticotropin stimulation test, and low-dose and high-dose dexamethasone tests. The patients were reevaluated at regular intervals (6, 12, and 24 months) for a median period of 24 months. Subclinical Cushing's syndrome (SCS) was diagnosed in patients with subtle hypercortisolism who did not present clinical signs of Cushing's syndrome.
RESULTS
We calculated the responsive index (peak value of ACTH in CRH test/baseline value of ACTH in CRH test). Of 23 patients, 6 had Cushing's syndrome, 8 had SCS, and 9 had a non-functioning tumor. All patients underwent laparoscopic adrenalectomy. Several patients (5 of 6 with Cushing's syndrome and 2 of 8 with SCS) required cortisol replacement therapy after surgery. The remaining patients required no hormonal replacement after surgery. Those who required hormone replacement had a responsive index of less than 1.2. Those who did not need hormone replacement therapy had a responsive index of more than 2.0.
CONCLUSIONS
In our limited experience, the responsive index of the CRH test might be a valuable tool for predicting the need for cortisol replacement after surgery in patients with SCS.

Keyword

Adrenalectomy; Corticotropin-releasing hormone; Cushing syndrome

MeSH Terms

Adenoma
Adrenalectomy
Adrenocorticotropic Hormone
Circadian Rhythm
Corticotropin-Releasing Hormone
Cushing Syndrome
Dexamethasone
Hormone Replacement Therapy
Humans
Hydrocortisone
Plasma
Retrospective Studies
Adrenocorticotropic Hormone
Corticotropin-Releasing Hormone
Dexamethasone
Hydrocortisone

Reference

1. Emral R, Uysal AR, Asik M, Gullu S, Corapcioglu D, Tonyukuk V, et al. Prevalence of subclinical Cushing's syndrome in 70 patients with adrenal incidentaloma: clinical, biochemical and surgical outcomes. Endocr J. 2003. 50:399–408.
2. Grumbach MM, Biller BM, Braunstein GD, Campbell KK, Carney JA, Godley PA, et al. Management of the clinically inapparent adrenal mass ("incidentaloma"). Ann Intern Med. 2003. 138:424–429.
3. Young WF Jr. Management approaches to adrenal incidentalomas. A view from Rochester, Minnesota. Endocrinol Metab Clin North Am. 2000. 29:159–185. x
4. Erbil Y, Ademoglu E, Ozbey N, Barbaros U, Yanik BT, Salmaslioglu A, et al. Evaluation of the cardiovascular risk in patients with subclinical Cushing syndrome before and after surgery. World J Surg. 2006. 30:1665–1671.
5. Chiodini I, Tauchmanova L, Torlontano M, Battista C, Guglielmi G, Cammisa M, et al. Bone involvement in eugonadal male patients with adrenal incidentaloma and subclinical hypercortisolism. J Clin Endocrinol Metab. 2002. 87:5491–5494.
6. Rossi R, Tauchmanova L, Luciano A, Di Martino M, Battista C, Del Viscovo L, et al. Subclinical Cushing's syndrome in patients with adrenal incidentaloma: clinical and biochemical features. J Clin Endocrinol Metab. 2000. 85:1440–1448.
7. Terzolo M, Pia A, Ali A, Osella G, Reimondo G, Bovio S, et al. Adrenal incidentaloma: a new cause of the metabolic syndrome? J Clin Endocrinol Metab. 2002. 87:998–1003.
8. Tauchmanova L, Rossi R, Biondi B, Pulcrano M, Nuzzo V, Palmieri EA, et al. Patients with subclinical Cushing's syndrome due to adrenal adenoma have increased cardiovascular risk. J Clin Endocrinol Metab. 2002. 87:4872–4878.
9. McLeod MK, Thompson NW, Gross MD, Bondeson AG, Bondeson L. Sub-clinical Cushing's syndrome in patients with adrenal gland incidentalomas. Pitfalls in diagnosis and management. Am Surg. 1990. 56:398–403.
10. Newell-Price J, Morris DG, Drake WM, Korbonits M, Monson JP, Besser GM, et al. Optimal response criteria for the human CRH test in the differential diagnosis of ACTH-dependent Cushing's syndrome. J Clin Endocrinol Metab. 2002. 87:1640–1645.
11. Nawata H, Demura H, Suda T, Takayanagi R. Adrenal preclinical cushing's syndrome. Annual report of "Disorders of adrenal hormones" Research Committee (fiscal year 1995). 1996. Tokyo: Japanese Ministry of Health and Welfare;223–226.
12. Matsuda T, Murota T, Kawakita M. Transperitoneal anterior laparoscopic adrenalectomy: the easiest technique. Biomed Pharmacother. 2000. 54:Suppl 1. 157s–160s.
13. Bertherat J, Mosnier-Pudar H, Bertagna X. Adrenal incidentalomas. Curr Opin Oncol. 2002. 14:58–63.
14. Reincke M, Nieke J, Krestin GP, Saeger W, Allolio B, Winkelmann W. Preclinical Cushing's syndrome in adrenal "incidentalomas": comparison with adrenal Cushing's syndrome. J Clin Endocrinol Metab. 1992. 75:826–832.
15. Ross NS. Epidemiology of Cushing's syndrome and subclinical disease. Endocrinol Metab Clin North Am. 1994. 23:539–546.
16. Kloos RT, Gross MD, Francis IR, Korobkin M, Shapiro B. Incidentally discovered adrenal masses. Endocr Rev. 1995. 16:460–484.
17. Caplan RH, Strutt PJ, Wickus GG. Subclinical hormone secretion by incidentally discovered adrenal masses. Arch Surg. 1994. 129:291–296.
18. Ambrosi B, Peverelli S, Passini E, Re T, Ferrario R, Colombo P, et al. Abnormalities of endocrine function in patients with clinically "silent" adrenal masses. Eur J Endocrinol. 1995. 132:422–428.
19. Barzon L, Scaroni C, Sonino N, Fallo F, Gregianin M, Macri C, et al. Incidentally discovered adrenal tumors: endocrine and scintigraphic correlates. J Clin Endocrinol Metab. 1998. 83:55–62.
20. Avgerinos PC, Chrousos GP, Nieman LK, Oldfield EH, Loriaux DL, Cutler GB Jr. The corticotropin-releasing hormone test in the postoperative evaluation of patients with cushing's syndrome. J Clin Endocrinol Metab. 1987. 65:906–913.
Full Text Links
  • KJU
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr