Systematic Hormonal Screening of Incidentally Discovered Adrenal Tumors Yields a High Detection of Hypercortisolism and Hyperaldosteronism

Presentation Number: SUN 408
Date of Presentation: April 2nd, 2017

Francisco J Guarda*1, Roberto Olmos1, Ignacio San Francisco1, Alvaro Zuñiga1, Alvaro Huete1, Gonzalo Mendez1, Anand Vaidya2 and Rene Baudrand1
1Pontificia Universidad Catolica de Chile, Santiago, Chile, 2Brigham and Women's Hospital, Harvard Medical School, Boston, MA

Abstract

INTRODUCTION: The detection of Adrenal Incidentalomas (AIs) is increasing. Current guidelines suggest that all AIs be screened for excess cortisol and cathecolamines to optimize early detection of subclinical and deleterious hormone excess, and to screen for primary aldosteronism (PA) only when there is concomitant hypertension and/or hypokalemia.

AIMS: To evaluate whether systematic and indiscriminate approach to screening for hormonal excess in AI could improve detection of adrenal hormone hyperfunction.

METHODS: We recruited 100 consecutive patients with AI. Measurements of morning ACTH, plasma aldosterone concentration (PAC) and plasma renin activity (PRA) were performed on all participants on day 1, followed by an overnight 1mg dexamethasone suppression test (DST) on day 2. Urine metanephrines were measured only in non-adenoma cases defined by an expert radiologist.

Hypercortisolism was defined by baseline ACTH<15 pg/mL and a DST cortisol >1.8 ug/dL. PA was defined as a positive oral sodium loading or saline suppression test in participants with a positive screen for PA (aldosterone-to-renin ratio (ARR)>20, with PAC>6 ng/dL and PRA<1 ng/mL/h).

RESULTS: The mean AI size was 25mm, with 15% of cases bilateral AI. The frequency of benign appearing adenomas was 76%, carcinoma was 3%, and pheochromocytoma was 6%. Functional tumors were detected in 45/100 of the cases, and of these 25/45 were confirmed to have hypercortisolism, 12/45 were confirmed to have PA (30% normotensives), 6/45 had a pheochromocytoma and 2/45 had a secretory adrenocortical carcinoma.

CONCLUSIONS: The systematic biochemical screening of adrenal incidentalomas resulted in a high detection of subclinical adrenal hormone excess. Given the high risk of incident cardiometabolic risk associated with hypercortisolism and hyperaldosteronism, our findings suggest that an unbiased screening approach to AI may increase the detection of functional tumors.

 

Nothing to Disclose: FJG, RO, IS, AZ, AH, GM, AV, RB