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Incidental adrenal nodules: Association with exaggerated 17-hydroxyprogesterone response to adrenocorticotropic hormone

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Abstract

The etiology of incidentally discovered, nonfunctional adrenal nodules was evaluated by using the 17-hydroxyprogesterone (17-OHP) response to synthetic adrenocorticotrophin (cosyntropin) (ACTH) administration. Patients who were discovered to have adrenal nodules and age-matched volunteers were studied. A total of 12 patients with adrenal nodules and 10 control subjects were studied. None of the patients with adrenal nodules had any evidence of hormonal hypersecretion consistent with pheochromocytoma, Cushing’s syndrome or hy-peraldosteronism. All subjects had serum 17-OHP and Cortisol responses measured at baseline and at 30 and 60 min following the intravenous administration of 250 μg of ACTH. Baseline 17-OHP levels in patients with adrenal nodules were not significantly different from those of the normal controls (adrenal nodules 17-OHP: 75±13 vs control 68±11 ng/dl). After stimulation with ACTH, both 30 min and 60 min 17-OHP levels in patients with adrenal nodules (322±47 and 361 ±54 ng/dl, respectively) were significantly elevated over the responses seen with the controls (169±29 ng/dl at 30 min, p<0.015, and 158±20 ng/dl at 60 min, p<0.004). Baseline and post-ACTH serum Cortisol levels were similar in both groups. Out of these twelve patients with adrenal nodules, nine were reevaluated twelve months later. In this group the basal 17-OHP remained comparable to normal levels (72±8.4 ng/dl) whereas the post-ACTH levels still remained exaggerated (30 and 60 min values 327±37 and 373±39 ng/dl). Our preliminary results show that an exaggerated 17-OHP response to ACTH may be a useful test to establish the benign nature of adrenal nodules. It is postulated that in some of these patients the adrenal tissue may have genetically determined or acquired 21-hydroxylase deficiency.

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Author notes

  1. David B. Turton MC, USN

    Present address: Division of Nuclear Medicine, National Naval Medical Center, Bethesda, Maryland, 20889-5000, USA

  2. John T. O’Brian M.D.

    Present address: Department of Medicine, Eastern Virginia Medical School, Norfolk, Virginia, 23510, USA

Authors and Affiliations

  1. Division of Endocrinology-Metabolism, Department of Internal Medicine, National Naval Medical Center Bethesda, Bethesda, Maryland, 20889-5000, USA

    David B. Turton MC, USN, John T. O’Brian M.D. &  K. M. M. Shakir MC, USN (Head)

  2. Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA

    David B. Turton MC, USN, John T. O’Brian M.D. &  K. M. M. Shakir MC, USN (Head)

Authors
  1. David B. Turton MC, USN
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  2. John T. O’Brian M.D.
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  3. K. M. M. Shakir MC, USN
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Additional information

The opinions and assertions contained herein are the private ones of the authors and are not to be construed as official or as reflecting the views of the Navy Department or the Naval Service at large.

This study was supported by a grant from the Clinical Investigation Program (#89-06-2465-00), National Naval Medical Center, Bethesda, Maryland and the Naval Health Sciences Education and Training Command, Bethesda, Maryland.

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Turton, D.B., O’Brian, J.T. & Shakir, K.M.M. Incidental adrenal nodules: Association with exaggerated 17-hydroxyprogesterone response to adrenocorticotropic hormone. J Endocrinol Invest 15, 789–796 (1992). https://doi.org/10.1007/BF03348806

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