Clinical Spectrum of Adrenal Cushing's Syndrome and the Caution for Interpretation of Adrenocorticotrophic Hormone: A Single-Center Experience.

Abstract

To describe the differences in presentation, biochemistry, and radiological evaluation of various etiologies of adrenal Cushing's syndrome (CS) from a single center. To emphasize caution for interpretation of plasma adrenocorticotropic hormone (ACTH), as a spuriously unsuppressed ACTH level by immunometric assay may lead to therapeutic misadventures in adrenal CS.

DESIGN:

 Retrospective, single-center, observational study.

METHODS:

  Fifty-eight adrenal CS patients [Adrenocortical carcinoma (ACC), n=30; Adenoma (ACA), n=15; Primary pigmented nodular adrenocortical disease (PPNAD), n=10; ACTH independent macronodular adrenal hyperplasia (AIMAH), n=3) evaluated at a tertiary care center in western India between January 2006 to March 2020 were included. Data on demography, clinical evaluation, biochemistry, imaging, management, histopathology, and outcome were recorded in a standard format and analyzed.

RESULTS:

  Cortisol secreting ACC presented at 38(1-50) years with abdominal mass in 26/30 (86.7%) and 16/30 (53.3%) had metastases at presentation. ACA with autonomous cortisol excess presented at 25(4.9-40) years with discriminating features of CS in 14/15 (93.3%), sex steroid production in 2/15, unenhanced HU <10 in only one, and relative washout >40% in 8/11 (72.7%). One ACA and eight ACC patients had plasma ACTH (by Siemens Immulite assay) > 20 pg/ml, despite hypercortisolemic state.

CONCLUSIONS:

  Cortisol-secreting ACC and ACA most often present with mass effects and florid CS, respectively. Baseline HU has low sensitivity to differentiate cortisol-secreting ACA from ACC. Plasma ACTH measured by Seimens Immulite is often unsuppressed, especially in ACC patients, which can be addressed by measuring ACTH by more accurate assays.

• Authors: Vikrant Gosavi, Anurag Lila, Saba Samad Memon, Vijaya Sarathi, Kunal Thakkar, Abhay Dalvi, Gaurav Malhotra, Gagan Prakash, Virendra Patil, Nalini S Shah, Tushar Bandgar
• Journal: Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme (Horm Metab Res) Vol. 54 Issue 2 Pg. 57-66 (Feb 2022) ISSN: 1439-4286 [Electronic] Germany
• PMID: 35130566 (Publication Type: Journal Article, Observational Study)
• Copyright: Thieme. All rights reserved.

Chemical References

• Adrenocorticotropic Hormone
• Hydrocortisone

Topics

• Adrenal Cortex Neoplasms (complications)
• Adrenocorticotropic Hormone
• Cushing Syndrome
• Humans
• Hydrocortisone
• Hyperplasia (complications)
• Retrospective Studies