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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
"hypertension"
symptom
achondroplasia
acute rheumatic fever
adrenal incidentaloma
aniridia
aromatase deficiency
cadasil
child syndrome
cohen syndrome
congenital adrenal hyperplasia
congenital diaphragmatic hernia
cushing syndrome
cystinuria
erdheim-chester disease
erythropoietic protoporphyria
esophageal adenocarcinoma
fabry disease
familial hypocalciuric hypercalcemia
gm1 gangliosidosis
heparin-induced thrombocytopenia
hereditary cerebral hemorrhage with amyloidosis
holt-oram syndrome
homocystinuria without methylmalonic aciduria
hydrocephalus with stenosis of the aqueduct of sylvius
inclusion body myositis
kallmann syndrome
kindler syndrome
lamellar ichthyosis
lymphangioleiomyomatosis
pendred syndrome
primary effusion lymphoma
scrub typhus
severe combined immunodeficiency
sneddon syndrome
typhoid
von hippel-lindau disease
well-differentiated liposarcoma
werner syndrome
x-linked adrenoleukodystrophy
zellweger syndrome
This symptom has already been validated