Subclinical hormone secretion by incidentally discovered adrenal masses

R. H. Caplan, P. J. Strutt and G. G. Wickus
Section of Endocrinology, Gundersen/Lutheran Medical Center, La Crosse, Wis.

OBJECTIVE: To determine the frequency of subclinical hormone secretion in incidentally discovered adrenal masses. DESIGN: We reviewed the radiologic reports of 1779 consecutive computed tomographic scans of the chest, abdomen, and pelvis. SETTING: Regional referral medical center. PATIENTS: Eighty-nine patients with abnormalities of one or both adrenal glands were identified. Patients with nonadrenal gland malignant neoplasms, primary aldosteronism, adrenal hemorrhage, and death or severe illness were not investigated. The final study group consisted of 26 patients with incidentally discovered adrenal masses. MAIN OUTCOME MEASURES: Aldosterone secretion was assessed by measuring plasma renin activity and the plasma aldosterone concentration in patients with unexplained hypokalemia. We evaluated cortisol secretion by performing a 1-mg overnight dexamethasone suppression test and by measuring the corticotropin concentration at 8 AM by a sensitive method. In patients with low corticotropin values, we also measured the 24-hour urinary excretion of free cortisol and 17-ketosteroids and assessed diurnal variation by measuring plasma cortisol concentrations at 8 AM and 4 PM. Adrenal medullary function was studied by measuring urinary free catecholamines. RESULTS: One patient had unrecognized primary aldosteronism, two patients had elevated free catecholamine excretion, and three patients (12%) had subclinical Cushing's syndrome. CONCLUSION: Based on our observations and a review of the literature, we conclude that subclinical hormone secretion, especially cortisol secretion, is more common in patients with incidentally discovered adrenal masses than previously appreciated. Surgeons and anesthesiologists must be alert to the possibility that adrenal insufficiency or a hypertensive crisis may develop in the perioperative period in patients with incidentally discovered adrenal masses.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Case Detection, Diagnosis, and Treatment of Patients with Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline
Funder et al.
J. Clin. Endocrinol. Metab. 2008;93:3266-3281.
ABSTRACT | FULL TEXT  

The Incidental Adrenal Mass on CT: Prevalence of Adrenal Disease in 1,049 Consecutive Adrenal Masses in Patients with No Known Malignancy
Song et al.
Am. J. Roentgenol. 2008;190:1163-1168.
ABSTRACT | FULL TEXT  

Upper pole of a duplex kidney mimicking adrenal incidentaloma in 18F-fluoro-2-deoxy-D-glucose positron emission tomography: a pitfall in diagnosis
Chan et al.
Br. J. Radiol. 2006;79:e50-e52.
ABSTRACT | FULL TEXT  

The Clinically Inapparent Adrenal Mass: Update in Diagnosis and Management
Mansmann et al.
Endocr. Rev. 2004;25:309-340.
ABSTRACT | FULL TEXT  

The Diagnostic Role of Radionuclide Imaging in Evaluation of Patients with Nonhypersecreting Adrenal Masses
Maurea et al.
JNM 2001;42:884-892.
ABSTRACT | FULL TEXT  

The Patients with Incidentally Discovered Adrenal Adenoma (Incidentaloma) Are Not at Increased Risk of Osteoporosis
Osella et al.
J. Clin. Endocrinol. Metab. 2001;86:604-607.
ABSTRACT | FULL TEXT  

Subclinical Cushing's Syndrome in Patients with Adrenal Incidentaloma: Clinical and Biochemical Features
Rossi et al.
J. Clin. Endocrinol. Metab. 2000;85:1440-1448.
ABSTRACT | FULL TEXT  

Growth Hormone (GH) Responses to GH-Releasing Hormone Alone or Combined with Arginine in Patients with Adrenal Incidentaloma: Evidence for Enhanced Somatostatinergic Tone
Terzolo et al.
J. Clin. Endocrinol. Metab. 2000;85:1310-1315.
ABSTRACT | FULL TEXT