Skip to main content
SpringerLink
Log in

Can abdominal CT features predict autonomous cortisol secretion in patients with adrenal nodules?

  • Kidneys, Ureters, Bladder, Retroperitoneum
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To determine if CT features of adrenal nodules and of the remainder of the abdomen can predict autonomous cortisol secretion (ACH) in patients with adrenal nodules, and to identify a nodule size threshold below which ACH is unlikely.

Methods

Retrospective review of adult patients with adrenal nodules who underwent CT of abdomen and 1-mg Dexamethasone suppression test within 1 year of each other. Patients were considered to have no ACH if serum cortisol was ≤ 1.8 µg/dL after the 1-mg dexamethasone suppression test and to have possible or definite autonomous cortisol secretion if serum cortisol was > 1.8 µg/dL. The following CT features were assessed: Adrenal nodule length, nodule width, unenhanced nodule attenuation, contralateral adrenal gland thickness, visceral and subcutaneous adipose tissue area, skeletal muscle area and density, and unenhanced liver attenuation.

Results

29 patients had no autonomous cortisol secretion and 29 patients had possible or definite autonomous cortisol secretion. Nodule length and width were the only two variables that significantly differed between patients with nonfunctional nodules and those with possibly or definitely functional nodules. Using a threshold nodule length of 1.5 cm, the sensitivity and specificity for predicting possible or definite autonomous cortisol secretion was 93.1% and 37.9%, respectively.

Conclusion

Autonomous cortisol secretion in patients with adrenal nodules correlates with increasing nodule size. A nodule length threshold of 1.5 cm provides 93.1% sensitivity for predicting possible or definite ACH based on the 1-mg Dexamethasone suppression test.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Song JH, Chaudhry FS, Mayo-Smith WW (2008) The incidental adrenal mass on CT: prevalence of adrenal disease in 1,049 consecutive adrenal masses in patients with no known malignancy. AJR American journal of roentgenology 190 (5):1163-1168. https://doi.org/10.2214/AJR.07.2799

    Article  PubMed  Google Scholar 

  2. Bovio S, Cataldi A, Reimondo G, Sperone P, Novello S, Berruti A, Borasio P, Fava C, Dogliotti L, Scagliotti GV, Angeli A, Terzolo M (2006) Prevalence of adrenal incidentaloma in a contemporary computerized tomography series. Journal of endocrinological investigation 29 (4):298-302. https://doi.org/10.1007/BF03344099

    Article  CAS  PubMed  Google Scholar 

  3. Young WF, Jr. (2007) Clinical practice. The incidentally discovered adrenal mass. The New England journal of medicine 356 (6):601–610. https://doi.org/10.1056/NEJMcp065470

  4. Garrett RW, Nepute JC, Hayek ME, Albert SG (2016) Adrenal Incidentalomas: Clinical Controversies and Modified Recommendations. AJR American journal of roentgenology 206 (6):1170-1178. https://doi.org/10.2214/AJR.15.15475

    Article  PubMed  Google Scholar 

  5. Di Dalmazi G, Pasquali R, Beuschlein F, Reincke M (2015) Subclinical hypercortisolism: a state, a syndrome, or a disease? European journal of endocrinology 173 (4):M61-71. https://doi.org/10.1530/EJE-15-0272

    Article  CAS  PubMed  Google Scholar 

  6. Debono M, Bradburn M, Bull M, Harrison B, Ross RJ, Newell-Price J (2014) Cortisol as a marker for increased mortality in patients with incidental adrenocortical adenomas. The Journal of clinical endocrinology and metabolism 99 (12):4462-4470. https://doi.org/10.1210/jc.2014-3007

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Bancos I, Alahdab F, Crowley RK, Chortis V, Delivanis DA, Erickson D, Natt N, Terzolo M, Arlt W, Young WF, Jr., Murad MH (2016) THERAPY OF ENDOCRINE DISEASE: Improvement of cardiovascular risk factors after adrenalectomy in patients with adrenal tumors and subclinical Cushing's syndrome: a systematic review and meta-analysis. European journal of endocrinology 175 (6):R283-R295. https://doi.org/10.1530/EJE-16-0465

    Article  CAS  PubMed  Google Scholar 

  8. Petramala L, Cavallaro G, Galassi M, Marinelli C, Tonnarini G, Concistre A, Costi U, Bufi M, Lucia P, De Vincentis G, Iannucci G, De Toma G, Letizia C (2017) Clinical Benefits of Unilateral Adrenalectomy in Patients with Subclinical Hypercortisolism Due to Adrenal Incidentaloma: Results from a Single Center. High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension 24 (1):69-75. https://doi.org/10.1007/s40292-017-0182-7

    Article  Google Scholar 

  9. Vaidya A, Hamrahian A, Bancos I, Fleseriu M, Ghayee HK (2019) The Evaluation of Incidentally Discovered Adrenal Masses. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists 25 (2):178-192. https://doi.org/10.4158/DSCR-2018-0565

    Article  Google Scholar 

  10. Fassnacht M, Arlt W, Bancos I, Dralle H, Newell-Price J, Sahdev A, Tabarin A, Terzolo M, Tsagarakis S, Dekkers OM (2016) Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. European journal of endocrinology 175 (2):G1-G34. https://doi.org/10.1530/EJE-16-0467

    Article  CAS  PubMed  Google Scholar 

  11. Bujawansa S, Bowen-Jones D (2011) Low investigation rate for adrenal incidentalomas. Endocrine 40 (1):134-136. https://doi.org/10.1007/s12020-011-9487-9

    Article  CAS  PubMed  Google Scholar 

  12. Davenport E, Lang Ping Nam P, Wilson M, Reid A, Aspinall S (2014) Adrenal incidentalomas: management in British district general hospitals. Postgraduate medical journal 90 (1065):365-369. https://doi.org/10.1136/postgradmedj-2013-132386

    Article  PubMed  Google Scholar 

  13. de Haan RR, Schreuder MJ, Pons E, Visser JJ (2019) Adrenal Incidentaloma and Adherence to International Guidelines for Workup Based on a Retrospective Review of the Type of Language Used in the Radiology Report. Journal of the American College of Radiology : JACR 16 (1):50-55. https://doi.org/10.1016/j.jacr.2018.08.011

    Article  PubMed  Google Scholar 

  14. Eldeiry LS, Alfisher MM, Callahan CF, Hanna NN, Garber JR (2018) The impact of an adrenal incidentaloma algorithm on the evaluation of adrenal nodules. Journal of clinical & translational endocrinology 13:39-45. https://doi.org/10.1016/j.jcte.2018.07.001

    Article  Google Scholar 

  15. Eldeiry LS, Garber JR (2008) Adrenal incidentalomas, 2003 to 2005: experience after publication of the National Institutes of Health consensus statement. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists 14 (3):279-284. https://doi.org/10.4158/EP.14.3.279

    Article  Google Scholar 

  16. Sahni P, Trivedi A, Omer A, Trivedi N (2016) Adrenal incidentalomas: are they being worked up appropriately? Journal of community hospital internal medicine perspectives 6 (5):32913. https://doi.org/10.3402/jchimp.v6.32913

    Article  PubMed  Google Scholar 

  17. Huayllas MKP, Sirineni GK, Smith LM, Gallagher JC, Singh RJ, Netzel BC, Kater CE (2020) Correlation Between Size and Function of Unilateral and Bilateral Adrenocortical Nodules: An Observational Study. AJR American journal of roentgenology 214 (4):800-807. https://doi.org/10.2214/AJR.19.21753

    Article  PubMed  Google Scholar 

  18. Mosconi C, Vicennati V, Papadopoulos D, Dalmazi GD, Morselli-Labate AM, Golfieri R, Pasquali R (2017) Can Imaging Predict Subclinical Cortisol Secretion in Patients With Adrenal Adenomas? A CT Predictive Score. AJR American journal of roentgenology 209 (1):122-129. https://doi.org/10.2214/AJR.16.16965

    Article  PubMed  Google Scholar 

  19. Park SY, Oh YT, Jung DC, Rhee Y (2015) Prediction of Adrenal Adenomas With Hypercortisolism by Using Adrenal Computed Tomography: Emphasis on Contralateral Adrenal Thinning. Journal of computer assisted tomography 39 (5):741-746. https://doi.org/10.1097/RCT.0000000000000269

    Article  PubMed  Google Scholar 

  20. Olsen H, Nordenstrom E, Bergenfelz A, Nyman U, Valdemarsson S, Palmqvist E (2012) Subclinical hypercortisolism and CT appearance in adrenal incidentalomas: a multicenter study from Southern Sweden. Endocrine 42 (1):164-173. https://doi.org/10.1007/s12020-012-9622-2

    Article  CAS  PubMed  Google Scholar 

  21. Ognjanovic S, Macut D, Petakov M, Elezovic Kovacevic V, Isailovic T, Bozic Antic I, Ilic D, Popovic B, Bogavac T, Pekmezovic T, Damjanovic S (2016) The Occurrence of Subclinical Hypercortisolism and Osteoporosis in Patients with Incidentally Discovered Unilateral and Bilateral Adrenal Tumors. Journal of medical biochemistry 35 (4):401-409. https://doi.org/10.1515/jomb-2016-0020

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Vassiliadi DA, Ntali G, Vicha E, Tsagarakis S (2011) High prevalence of subclinical hypercortisolism in patients with bilateral adrenal incidentalomas: a challenge to management. Clinical endocrinology 74 (4):438-444. https://doi.org/10.1111/j.1365-2265.2010.03963.x

    Article  PubMed  Google Scholar 

  23. Delivanis DA, Iniguez-Ariza NM, Zeb MH, Moynagh MR, Takahashi N, McKenzie TJ, Thomas MA, Gogos C, Young WF, Bancos I, Kyriazopoulou V (2018) Impact of hypercortisolism on skeletal muscle mass and adipose tissue mass in patients with adrenal adenomas. Clinical endocrinology 88 (2):209-216. https://doi.org/10.1111/cen.13512

    Article  CAS  PubMed  Google Scholar 

  24. Debono M, Prema A, Hughes TJ, Bull M, Ross RJ, Newell-Price J (2013) Visceral fat accumulation and postdexamethasone serum cortisol levels in patients with adrenal incidentaloma. The Journal of clinical endocrinology and metabolism 98 (6):2383-2391. https://doi.org/10.1210/jc.2012-4276

    Article  CAS  PubMed  Google Scholar 

  25. Yener S, Baris M, Peker A, Demir O, Ozgen B, Secil M (2017) Autonomous cortisol secretion in adrenal incidentalomas and increased visceral fat accumulation during follow-up. Clinical endocrinology 87 (5):425-432. https://doi.org/10.1111/cen.13408

    Article  CAS  PubMed  Google Scholar 

  26. Rockall AG, Sohaib SA, Evans D, Kaltsas G, Isidori AM, Monson JP, Besser GM, Grossman AB, Reznek RH (2003) Computed tomography assessment of fat distribution in male and female patients with Cushing's syndrome. European journal of endocrinology 149 (6):561-567. https://doi.org/10.1530/eje.0.1490561

    Article  CAS  PubMed  Google Scholar 

  27. Rockall AG, Sohaib SA, Evans D, Kaltsas G, Isidori AM, Monson JP, Besser GM, Grossman AB, Reznek RH (2003) Hepatic steatosis in Cushing's syndrome: a radiological assessment using computed tomography. European journal of endocrinology 149 (6):543-548. https://doi.org/10.1530/eje.0.1490543

    Article  CAS  PubMed  Google Scholar 

  28. Targher G, Bertolini L, Rodella S, Zoppini G, Zenari L, Falezza G (2006) Associations between liver histology and cortisol secretion in subjects with nonalcoholic fatty liver disease. Clinical endocrinology 64 (3):337-341. https://doi.org/10.1111/j.1365-2265.2006.02466.x

    Article  CAS  PubMed  Google Scholar 

  29. Boyce CJ, Pickhardt PJ, Kim DH, Taylor AJ, Winter TC, Bruce RJ, Lindstrom MJ, Hinshaw JL (2010) Hepatic steatosis (fatty liver disease) in asymptomatic adults identified by unenhanced low-dose CT. AJR American journal of roentgenology 194 (3):623-628. https://doi.org/10.2214/AJR.09.2590

    Article  PubMed  Google Scholar 

  30. Haan RR, Visser JBR, Pons E, Feelders RA, Kaymak U, Hunink MGM, Visser JJ (2017) Patient-specific workup of adrenal incidentalomas. European journal of radiology open 4:108-114. https://doi.org/10.1016/j.ejro.2017.08.002

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Number UL1 TR001860. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Author information

Authors and Affiliations

  1. Department of Radiology, Davis Medical Center, University of California, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA

    Michael T. Corwin & Thomas W. Loehfelm

  2. Davis School of Medicine, University of California, Education Building, 4610 X Street, Sacramento, CA, 95817, USA

    Christopher Lan

  3. Davis Department of Public Health Sciences, University of California, One Shields Avenue, Med-Sci 182 B, Davis, CA, 95616, USA

    Machelle Wilson

  4. Department of Surgery, Davis Medical Center, University of California, 2221 Stockton Blvd., Sacramento, CA, 95817, USA

    Michael J. Campbell

Authors
  1. Michael T. Corwin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher Lan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Machelle Wilson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thomas W. Loehfelm
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael J. Campbell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael T. Corwin.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Corwin, M.T., Lan, C., Wilson, M. et al. Can abdominal CT features predict autonomous cortisol secretion in patients with adrenal nodules?. Abdom Radiol 46, 4338–4344 (2021). https://doi.org/10.1007/s00261-021-03110-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-021-03110-y

Keywords

Search

Navigation