HPA Axis: Accuracy of several parameters of hypothalamic–pituitary–adrenal axis activity in predicting before surgery the metabolic effects of the rem

European Journal of Endocrinology (2010) In press
DOI: 10.1530 / EJE-10-0602
Copyright © 2010 by European Society of Endocrinology

Cristina Eller-Vainicher, Valentina Morelli, Antonio Stefano Salcuni, Claudia Battista, Massimo Torlontano, Francesca Coletti, Laura Iorio, Elisa Cairoli, Paolo Beck-Peccoz, Maura Arosio, Bruno Ambrosi, Alfredo Scillitani and Iacopo Chiodini

C Eller-Vainicher, Department of Medical Sciences, Endocrinology and Diabetology Unit, Fondazione Ospedale Maggiore Policlinico, I.R.C.C.S., Milan, Italy
V Morelli, Milan, 20122, Italy
A Salcuni, Endocrinology Unit, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
C Battista, Endocrinology Unit, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
M Torlontano, Endocrinology Unit, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
F Coletti, Endocrinology Unit, Ospedale San Giuseppe Multimedica, Milan, Italy
L Iorio, Policlinico San Donato Institute, I.R.C.C.S.Depertment of Medical and Surgical Sciences, University of Milan, san Donato Milanese, Milan, Italy
E Cairoli, Department of Medical Sciences, Endocrinology and Diabetology Unit, Fondazione Ospedale Maggiore Policlinico, I.R.C.C.S., Milan, Italy
P Beck-Peccoz, Department of Medical Sciences, Endocrinology and Diabetology Unit, Fondazione Ospedale Maggiore Policlinico, I.R.C.C.S., Milan, Italy
M Arosio, University of Milan, Milan, Italy
B Ambrosi, Policlinico San Donato Institute, I.R.C.C.S.Depertment of Medical and Surgical Sciences, University of Milan, san Donato Milanese, Milan, Italy
A Scillitani, Endocrinology Unit, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
I Chiodini, Department of Medical Sciences, Endocrinology and Diabetology Unit, Fondazione Ospedale Maggiore Policlinico, I.R.C.C.S., Milano, 20123, Italy

Correspondence: Iacopo Chiodini, Email: iacopo.chiodini@email.it

Context: It is unknown if the metabolic effects of the removal of an adrenal incidentalomas (AI) can be predicted by the assessment of cortisol hypersecretion before surgery.

Objective: To evaluate the accuracy of several criteria of hypothalamic-pituitary-adrenal axis activity in predicting the metabolic outcome after adrenalectomy.

Design: Retrospective longitudinal study.

Patients: In 55 surgically-treated AI patients (Group 1) before surgery and in 53 non-treated AI patients (Group 2) at baseline, urinary free cortisol (UFC), cortisol after 1mg-overnight dexamethasone-suppression test (1mg-DST), ACTH and midnight serum cortisol (MSC) were measured. In Group 1 and 2, metabolic parameters were evaluated before and 29.6±13.8 months after surgery and at baseline and after 35.2±10.9 months, respectively.

Main Outcome Measures: The improvement/worsening of weight, blood pressure, glucose and cholesterol levels (endpoints) was defined in the presence of a >5% weight decrease/increase and following the European Society of Cardiology or the ATPIII criteria, respectively. The accuracy of UFC, 1mg-DST, ACTH and MSC, singularly taken or in combination, in predicting the improvement/worsening of ≥2 endpoints was calculated.

Results: The presence of ≥2 among UFC>70 µg/24h (193 nmol/L), ACTH<10>3.0 µg/dL (83 nmol/L) (UFC-ACTH-DST criterion) had the best accuracy in predicting the endpoints’ improvement (sensitivity 65.2%, specificity 68.8%) after surgery. In the non-treated AI patients, this criterion predicted the worsening of ≥2 endpoints (sensitivity 55.6%, specificity 82.9%).

Conclusions: The UFC-ACTH-DST criterion seems the best for predicting the metabolic outcome in surgically-treated AI patients.

From http://www.eje.org/cgi/content/abstract/EJE-10-0602v1