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Subclinical hypercortisolism and CT appearance in adrenal incidentalomas: a multicenter study from Southern Sweden.
[adrenal incidentaloma]
Evaluation
of
subclinical
hypercortisolism
(
SH
)
in
patients
with
adrenal
incidentaloma
(
AI
)
including
its
correlation
to
size
,
attenuation
at
unenhanced
computed
tomography
(
CT
)
and
unilateral
or
bilateral
adrenal
disease
.
Nine
hospitals
in
Southern
Sweden
investigated
during
2005
-
2007
consecutively
patients
with
AI
with
hormonal
and
CT
examinations
according
a
regional
protocol
.
Two
hundred
and
twenty-
eight
patients
with
AI
with
median
size
2
.
0
cm
were
included
.
One
mg
overnight
dexamethasone
suppression
test
(
DST
)
was
performed
in
223
patients
and
basal
P-ACTH
measured
in
146
patients
.
SH
was
defined
as
cortisol
≥
50
nmol
/
l
at
DST
in
combination
with
basal
ACTH
<
2
pmol
/
l
.
In
patients
with
unilateral
AI
42
%
(
76
/
180
)
had
inadequate
suppression
at
DST
and
23
%
(
27
/
115
)
had
SH
.
The
probability
for
SH
and
inadequate
suppression
at
DST
correlated
positively
to
size
and
inversely
to
attenuation
at
CT
.
Bilateral
AI
were
found
in
43
patients
and
of
these
70
%
(
30
/
43
)
had
inadequate
suppression
at
DST
and
42
%
(
13
/
31
)
SH
.
The
patients
with
SH
or
inadequate
suppression
at
DST
had
increased
frequency
of
hypertension
which
increased
further
in
patients
with
post-
DST
cortisol
≥
140
nmol
/
l
.
The
applied
criterion
for
SH
is
useful
for
initial
evaluation
of
patients
with
AI
.
SH
is
common
in
patients
with
AI
,
particular
in
bilateral
disease
.
In
patients
with
unilateral
AI
the
probability
for
SH
correlated
positively
to
size
and
inversely
to
attenuation
at
CT
.
Furthermore
,
SH
and
the
post-
DST
cortisol
concentration
was
associated
with
hypertension
.
Diseases
Validation
Diseases presenting
"bilateral adrenal disease"
symptom
adrenal incidentaloma
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