Context Adrenal incidentaloma (AI) guidelines classify patients with suppressed 1 mg dexamethasone suppression test cortisol <Emphasis Type="BoldItalic">(F)</Emphasis> below 50nmol/l as non-functioning in terms of cortisol autonomy and denies the necessity of metabolic follow-up. However, cardiometabolic risk and disturbed quality of life was shown in those patients. We aimed to establish daily cortisol exposure by salivary cortisol sampling at three different time frames and evaluate whether patients with suppressed <Emphasis Type="BoldItalic">(F)</Emphasis> are exposed to cortisol excess. Design Cross-sectional and prospective. Patients In 138 AI patients referred to our unit, 101 patients were enrolled. We included healthy volunteers without any adrenal disorders (n = 30) and patients with Cushing’s syndrome evaluated during the study timeline (n = 16). Adrenal incidentaloma patients were divided into categories with respect to <Emphasis Type="BoldItalic">(F)</Emphasis>. Measurements Anthropometric characteristics, previous history of cardiovascular events, plasma corticotrophin (ACTH), serum dehydroepiandrostenadione-sulfate (DHEAS) and <Emphasis Type="BoldItalic">(F)</Emphasis> were recorded. Saliva collection for the assessment of cortisol concentration was performed at the morning (SLCMN), afternoon (SLCAN) and late night (SLCLN). Results SLCAN and SLCLN of AI patients, irrespective of their <Emphasis Type="BoldItalic">F</Emphasis> levels, were significantly increased when compared to healthy controls. Further analysis showed that SLCAN and SLCLN concentrations were significantly elevated in patients with <Emphasis Type="BoldItalic">F</Emphasis> [25-49nmol/l] compared to healthy controls. Diurnal rhythm of cortisol had a similar pattern in healthy controls and all AI subjects irrespective of their <Emphasis Type="BoldItalic">F</Emphasis> category while the amplitude of secretion was concordant with <Emphasis Type="BoldItalic">F</Emphasis>. Conclusions Adrenal incidentaloma patients categorized as non-functioning by the current criteria of <Emphasis Type="BoldItalic">(F)</Emphasis>, could feature an increased exposure cortisol secretion. Clinical trial number Not applicable.

Estimation of cortisol exposure in patients with adrenal incidentalomas

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2025年11月17日

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Serkan Yener,
Gamze Tuna,
Husniye Sahin,
Suleyman Cem Adiyaman,
Basak Ozgen Saydam,
Mustafa Baris,
Gul Huray Islekel

摘要

Context

Adrenal incidentaloma (AI) guidelines classify patients with suppressed 1 mg dexamethasone suppression test cortisol (F) below 50nmol/l as non-functioning in terms of cortisol autonomy and denies the necessity of metabolic follow-up. However, cardiometabolic risk and disturbed quality of life was shown in those patients. We aimed to establish daily cortisol exposure by salivary cortisol sampling at three different time frames and evaluate whether patients with suppressed (F) are exposed to cortisol excess.

Design

Cross-sectional and prospective.

Patients

In 138 AI patients referred to our unit, 101 patients were enrolled. We included healthy volunteers without any adrenal disorders (n = 30) and patients with Cushing’s syndrome evaluated during the study timeline (n = 16). Adrenal incidentaloma patients were divided into categories with respect to (F).

Measurements

Anthropometric characteristics, previous history of cardiovascular events, plasma corticotrophin (ACTH), serum dehydroepiandrostenadione-sulfate (DHEAS) and (F) were recorded. Saliva collection for the assessment of cortisol concentration was performed at the morning (SLC_MN), afternoon (SLC_AN) and late night (SLC_LN).

Results

SLC_AN and SLC_LN of AI patients, irrespective of their F levels, were significantly increased when compared to healthy controls. Further analysis showed that SLC_AN and SLC_LN concentrations were significantly elevated in patients with F [25-49nmol/l] compared to healthy controls. Diurnal rhythm of cortisol had a similar pattern in healthy controls and all AI subjects irrespective of their F category while the amplitude of secretion was concordant with F.

Conclusions

Adrenal incidentaloma patients categorized as non-functioning by the current criteria of (F), could feature an increased exposure cortisol secretion.

Clinical trial number

Not applicable.