The Role of Adrenal Scintigraphy in the Diagnosis of Subclinical Cushing's Syndrome and the Prediction of Post-surgical Hypoadrenalism

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2014 Mar 12

PMID 24615601

Citations 10

Authors

Maria Pia Ricciato

Vincenzo Di Donna

Germano Perotti

Alfredo Pontecorvi

Rocco Bellantone

Salvatore M Corsello

Affiliations

Soon will be listed here.

Abstract

Background: Management of subclinical Cushing's syndrome (SCS) remains controversial; it is not possible to predict which patients would benefit from adrenalectomy. In the present study we aimed to evaluate the role of adrenocortical scintigraphy (ACS) in the management of patients with SCS.

Methods: The medical records of 33 consecutive patients with adrenal "incidentaloma" and proven or suspected SCS who underwent (131)I-19-iodocholesterol ACS between 2004 and 2010 were reviewed. Sixteen underwent laparoscopic adrenalectomy (surgical group-S-group) and 17 were medically managed (medical group-M-group). Follow-up evaluation was obtained by outpatient consultation.

Results: Overall 25 patients (15 in the S-group and 10 in the M-group) had concordant unilateral uptake at ACS (ACS+). In the S-group, the mean follow-up duration was 30.9 ± 16.1 months and, irrespective of the presence of hormonal diagnosis of SCS, in patients who were ACS+ adrenalectomy resulted in a significant increase in HDL cholesterol and decreases in body mass index, glycemia, and blood pressure (BP). One patient reduced antihypertensive medication and three others were able to discontinue it altogether. Prolonged postoperative hypoadrenalism (PH) occurred in 14 patients in the S-group. The overall accuracy in predicting PH was 93.7 % for ACS and 68.7 % for laboratory findings. In the M-group, the mean follow-up duration was 31.5 ± 26.3 months and no patient developed overt Cushing's syndrome, although ACS+ patients experienced a worsening in glycemia and diastolic BP.

Conclusions: Adrenal scintigraphy seems the most accurate diagnostic test for SCS. It is able to predict the metabolic outcome and the occurrence of PH, identifying the patients who could benefit from adrenalectomy irrespective of hormonal diagnosis.

Citing Articles

Comparison of adrenalectomy with conservative treatment on mild autonomous cortisol secretion: a systematic review and meta-analysis.

Khadembashiri M, Mohseni S, Harandi H, Pejman Sani M, Khadembashiri M, Atlasi R Front Endocrinol (Lausanne). 2024; 15:1374711.

PMID: 38808111 PMC: 11131104. DOI: 10.3389/fendo.2024.1374711.

Adrenalectomy improves blood pressure control in nonfunctioning adrenal incidentalomas and glycemic and lipid control in patients with autonomous cortisol secretion.

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The role of adrenal venous sampling (AVS) in primary bilateral macronodular adrenocortical hyperplasia (PBMAH): a study of 16 patients.

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Frequently asked questions and answers (if any) in patients with adrenal incidentaloma.

Ceccato F, Barbot M, Scaroni C, Boscaro M J Endocrinol Invest. 2021; 44(12):2749-2763.

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Adrenal Vein Cortisol to Metanephrine Ratio for Localizing ACTH-Independent Cortisol-Producing Adenoma: A Case Report.

Raj R, Kern P, Ghanta N, Uy E, Asadipooya K J Endocr Soc. 2021; 5(4):bvab009.

PMID: 33644621 PMC: 7881758. DOI: 10.1210/jendso/bvab009.

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