ACTH following overnight dexamethasone suppression can be used in the verification of autonomous cortisol secretion in patients with adrenal incidentalomas
Puvaneswaralingam, Shobitha ; Kjellbom, Albin LU
; Lindgren, Ola
LU
; Löndahl, Magnus
LU
and Olsen, Henrik
LU
(2021)
In Clinical Endocrinology
94(2).
p.168-175
- Abstract
Objective: During the investigation of adrenal incidentalomas, it is important to accurately diagnose autonomous cortisol secretion (ACS) but the specificity of cortisol ≥50 nmol/L after overnight dexamethasone suppression (cortisolONDST) is low. Therefore, ACTH following overnight dexamethasone suppression (ACTHONDST) and cortisol following a 2-day dexamethasone suppression test (cortisol2-DAYDST) were examined as markers of HPA axis suppression during ONDST. Design: This cross-sectional study examined patients with adrenal incidentalomas and basal ACTH ≥ 2.0 pmol/L who underwent ONDST. Measurements: ACTHONDST/ACTH ratio (ACTH ratio) was calculated for all patients. To define cut-off levels... (More)
Objective: During the investigation of adrenal incidentalomas, it is important to accurately diagnose autonomous cortisol secretion (ACS) but the specificity of cortisol ≥50 nmol/L after overnight dexamethasone suppression (cortisolONDST) is low. Therefore, ACTH following overnight dexamethasone suppression (ACTHONDST) and cortisol following a 2-day dexamethasone suppression test (cortisol2-DAYDST) were examined as markers of HPA axis suppression during ONDST. Design: This cross-sectional study examined patients with adrenal incidentalomas and basal ACTH ≥ 2.0 pmol/L who underwent ONDST. Measurements: ACTHONDST/ACTH ratio (ACTH ratio) was calculated for all patients. To define cut-off levels for ACTHONDST and ACTH ratio as markers of HPA axis suppression, ROC curves were used to separate patients with cortisolONDST <50 and ≥50 nmol/L. Results: CortisolONDST was ≥50 nmol/L in 140 out of 373 patients. In patients with cortisolONDST <50 nmol/L, ACTHONDST was 0.28 pmol/L (<0.23–2.7). DHEAS was positively correlated to ACTHONDST, demonstrating a 9% increase with a doubling in ACTHONDST, p = 0.02. The best cut-off levels for ACTHONDST and ACTH ratio to detect cortisolONDST ≥50 nmol/L were ≥0.6 pmol/L and ≥18% respectively. These cut-off levels were tested on patients with cortisolONDST <50 nmol/L, considered to have adequate suppression (n = 233), and patients with reduction of ≥50 nmol/L from cortisolONDST to cortisol2-DAYDST, who were considered to have inadequate suppression (n = 16). ACTHONDST ≥0.6 pmol/L and ACTH ratio ≥18% had a sensitivity of 75% and 81% respectively, and a specificity of 78% and 85% respectively, for detecting patients with inadequate suppression. Conclusions: ACTHONDST and ACTH ratio can be markers of HPA axis suppression in the investigation of adrenal incidentalomas. CortisolONDST ≥50 nmol/L with ACTHONDST <0.6 pmol/L or ACTH ratio <18% should lead to the suspicion of ACS.
(Less)
- author
- Puvaneswaralingam, Shobitha
; Kjellbom, Albin
LU
; Lindgren, Ola
LU
; Löndahl, Magnus
LU
and Olsen, Henrik
LU
- organization
- publishing date
- 2021
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- adrenal incidentaloma, adrenocortical adenomas, adrenocorticotropic hormone, adult, cross-sectional studies, dexamethasone, hypothalamic–pituitary–adrenal axis
- in
- Clinical Endocrinology
- volume
- 94
- issue
- 2
- pages
- 168 - 175
- publisher
- Wiley-Blackwell
- external identifiers
-
- pmid:33108675
- scopus:85096658576
- ISSN
- 0300-0664
- DOI
- 10.1111/cen.14357
- language
- English
- LU publication?
- yes
- id
- aa936c6b-8e78-4168-b70b-ca90b4d2e80a
- date added to LUP
- 2020-12-07 14:55:51
- date last changed
- 2024-06-13 01:54:40
@article{aa936c6b-8e78-4168-b70b-ca90b4d2e80a,
abstract = {{<p>Objective: During the investigation of adrenal incidentalomas, it is important to accurately diagnose autonomous cortisol secretion (ACS) but the specificity of cortisol ≥50 nmol/L after overnight dexamethasone suppression (cortisol<sub>ONDST</sub>) is low. Therefore, ACTH following overnight dexamethasone suppression (ACTH<sub>ONDST</sub>) and cortisol following a 2-day dexamethasone suppression test (cortisol<sub>2-DAYDST</sub>) were examined as markers of HPA axis suppression during ONDST. Design: This cross-sectional study examined patients with adrenal incidentalomas and basal ACTH ≥ 2.0 pmol/L who underwent ONDST. Measurements: ACTH<sub>ONDST</sub>/ACTH ratio (ACTH ratio) was calculated for all patients. To define cut-off levels for ACTH<sub>ONDST</sub> and ACTH ratio as markers of HPA axis suppression, ROC curves were used to separate patients with cortisol<sub>ONDST</sub> <50 and ≥50 nmol/L. Results: Cortisol<sub>ONDST</sub> was ≥50 nmol/L in 140 out of 373 patients. In patients with cortisol<sub>ONDST</sub> <50 nmol/L, ACTH<sub>ONDST</sub> was 0.28 pmol/L (<0.23–2.7). DHEAS was positively correlated to ACTH<sub>ONDST</sub>, demonstrating a 9% increase with a doubling in ACTH<sub>ONDST</sub>, p = 0.02. The best cut-off levels for ACTH<sub>ONDST</sub> and ACTH ratio to detect cortisol<sub>ONDST</sub> ≥50 nmol/L were ≥0.6 pmol/L and ≥18% respectively. These cut-off levels were tested on patients with cortisol<sub>ONDST</sub> <50 nmol/L, considered to have adequate suppression (n = 233), and patients with reduction of ≥50 nmol/L from cortisol<sub>ONDST</sub> to cortisol<sub>2-DAYDST</sub>, who were considered to have inadequate suppression (n = 16). ACTH<sub>ONDST</sub> ≥0.6 pmol/L and ACTH ratio ≥18% had a sensitivity of 75% and 81% respectively, and a specificity of 78% and 85% respectively, for detecting patients with inadequate suppression. Conclusions: ACTH<sub>ONDST</sub> and ACTH ratio can be markers of HPA axis suppression in the investigation of adrenal incidentalomas. Cortisol<sub>ONDST</sub> ≥50 nmol/L with ACTH<sub>ONDST</sub> <0.6 pmol/L or ACTH ratio <18% should lead to the suspicion of ACS.</p>}},
author = {{Puvaneswaralingam, Shobitha and Kjellbom, Albin and Lindgren, Ola and Löndahl, Magnus and Olsen, Henrik}},
issn = {{0300-0664}},
keywords = {{adrenal incidentaloma; adrenocortical adenomas; adrenocorticotropic hormone; adult; cross-sectional studies; dexamethasone; hypothalamic–pituitary–adrenal axis}},
language = {{eng}},
number = {{2}},
pages = {{168--175}},
publisher = {{Wiley-Blackwell}},
series = {{Clinical Endocrinology}},
title = {{ACTH following overnight dexamethasone suppression can be used in the verification of autonomous cortisol secretion in patients with adrenal incidentalomas}},
url = {{http://dx.doi.org/10.1111/cen.14357}},
doi = {{10.1111/cen.14357}},
volume = {{94}},
year = {{2021}},
}