Abstract | Background: Objectives: This study aimed to investigate the prevalence of CAH in a population with adrenal incidentalomas and report the clinical characterization. Material and methods: This was a prospective study performed at a regional hospital from 2016 to 2021. Patients with adrenal incidentalomas were investigated with an adrenocorticotropic hormone ( ACTH)-stimulation test in addition to hormonal workup. Serum cortisol and 17-hydroxyprogesterone (17OHP) were analyzed. Individuals with a basal or stimulated 17OHP ≥30 nmol/L were classified as suspicious non-classic CAH, and a CYP21A2-gene analysis was performed in these subjects. Results: In total, 320 individuals with adrenal incidentalomas were referred to the center, and of these individuals, an ACTH-stimulation test was performed in 222 (median age, 67 (24-87) years; 58.6% women; and 11.7% with bilateral lesions). None of the individuals presented a basal 17OHP ≥30 nmol/L, but there were 8 (3.6%) who did after ACTH stimulation. Four of these subjects (50%) presented bilateral lesions, and the tumor size was larger compared to that of the individuals with a stimulated 17OHP <30 nmol/L (median, 38 (19-66) vs. 19 (11-85) mm, p=0.001). A CYP21A2 variation (p.Val282Leu) was detected in one of the eight subjects with a stimulated 17OHP ≥30 nmol/L, i.e., the patient was a heterozygotic carrier. None of the eight subjects presented with cortisol insufficiency or clinical signs of hyperandrogenism. Conclusions: The prevalence of non-classic CAH in an adrenal incidentaloma cohort was 3.6% based on stimulated 17OHP and 0% based on gene analysis. CAH should be considered in AI management in selected cases and confirmed by genetic analysis.
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Authors | Fredrik Sahlander, Sophie Bensing, Henrik Falhammar |
Journal | Frontiers in endocrinology
(Front Endocrinol (Lausanne))
Vol. 13
Pg. 1017303
( 2022)
ISSN: 1664-2392 [Print] Switzerland |
PMID | 36545328
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2022 Sahlander, Bensing and Falhammar. |
Chemical References |
- 17-alpha-Hydroxyprogesterone
- Adrenocorticotropic Hormone
- CYP21A2 protein, human
- Hydrocortisone
- Steroid 21-Hydroxylase
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Topics |
- Aged
- Female
- Humans
- Male
- 17-alpha-Hydroxyprogesterone
- Adrenal Gland Neoplasms
(complications, epidemiology, genetics)
- Adrenal Hyperplasia, Congenital
(complications, diagnosis, epidemiology)
- Adrenocorticotropic Hormone
- Hydrocortisone
- Prospective Studies
- Steroid 21-Hydroxylase
(genetics)
- Sweden
- Young Adult
- Adult
- Middle Aged
- Aged, 80 and over
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