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Cortisol secretion from adrenal adenomas discovered as incidentalomas is responsive to ACTH.
[adrenal incidentaloma]
Adrenal
adenomas
discovered
as
incidentalomas
may
secrete
cortisol
and
cause
subclinical
hypercortisolism
.
This
cortisol
secretion
is
considered
to
be
autonomous
.
The
aim
was
to
investigate
whether
cortisol
secretion
by
adenomas
is
responsive
to
ACTH
.
Descriptive
retrospective
study
of
consecutive
patients
.
Eighty
patients
found
to
have
adrenal
incidentalomas
during
2008
and
2009
at
our
hospital
were
examined
,
and
50
patients
with
a
unilateral
adenoma
were
included
in
the
study
.
Cortisol
and
ACTH
were
measured
at
baseline
and
using
1
-
mg
overnight
dexamethasone
suppression
test
(
DST
)
.
The
cortisol
response
to
ACTH
was
calculated
using
the
expression
:
(
cortisolbasal
-
cortisolDST
)
/
(
ACTHbasal
-
ACTHDST
)
.
The
patients
were
divided
into
three
groups
according
to
their
basal
ACTH
:
≥
3
·
0
pm
(
29
patients
)
,
2
·
0
-
2
·
9
pm
(
9
patients
)
and
<
2
·
0
pm
(
12
patients
)
.
Cortisol
at
DST
was
similar
in
the
three
groups
:
30
,
46
and
43
nm
(
P
=
0
·
10
)
.
The
cortisol
response
to
ACTH
increased
stepwise
between
the
groups
:
98
,
172
and
249
nm
/
pm
(
P
=
0
·
000
,
undetectable
ACTH
was
set
to
0
pm
)
.
Basal
ACTH
was
negatively
correlated
with
the
size
of
the
adenoma
and
positively
correlated
with
the
attenuation
of
the
adenoma
at
unenhanced
CT
(
P
=
0
·
03
and
P
=
0
·
04
,
respectively
)
.
Patients
with
adrenal
adenomas
and
low
basal
ACTH
show
increased
cortisol
response
to
ACTH
,
and
the
adenomas
seem
to
be
the
source
of
the
increased
cortisol
secretion
.
The
increased
response
to
ACTH
could
be
a
pathogenic
factor
in
metabolic
complications
of
subclinical
hypercortisolism
.
The
cortisol
response
to
ACTH
may
therefore
be
a
useful
measure
of
subclinical
hypercortisolism
.
