Beyond symptomatology: A comparative analysis of unilateral and bilateral macronodular mild autonomous cortisol secretion

Author:

Barlas Tugba1ORCID,Gultekin Isil Imge2ORCID,Altintop Sabri Engin1ORCID,Cindil Emetullah2ORCID,Yalcin Mehmet Muhittin1ORCID,Cerit Ethem Turgay1ORCID,Sozen Tevfik Sinan3ORCID,Poyraz Aylar4ORCID,Altinova Alev Eroglu1ORCID,Toruner Fusun Balos1ORCID,Karakoc Mehmet Ayhan1ORCID,Akturk Mujde1ORCID

Affiliation:

1. Department of Endocrinology and Metabolism Gazi University, Faculty of Medicine Ankara Turkey

2. Department of Radiology Gazi University, Faculty of Medicine Ankara Turkey

3. Department of Urology Gazi University, Faculty of Medicine Ankara Turkey

4. Department of Pathology Gazi University, Faculty of Medicine Ankara Turkey

Abstract

AbstractObjectiveTo investigate the clinical, laboratory findings and signal intensity index (SII) on magnetic resonance imaging (MRI) of patients with bilateral and unilateral macronodular mild autonomous cortisol secretion (MACS).Patients and MeasurementsClinical and laboratory findings of 81 patients with MACS were examined from retrospective records. SII of adenomas and internodular areas were evaluated by MRI. The unilateral group included patients with an adrenal macronodule (≥1 cm) in a single adrenal gland, while the bilateral group included patients with at least one macronodule in both adrenal glands.ResultsIn total, 46 patients were in the unilateral (57%), while 35 (43%) patients were in the bilateral groups. The dehydroepiandrosterone sulphate (DHEA‐S) level was lower in the unilateral than in the bilateral group (p < .001). The presence of type 2 diabetes mellitus (T2DM), glycosylated haemoglobin (HbA1c) and low‐density lipoprotein (LDL) concentrations were higher in the bilateral group (p < .05). However, no significant difference was detected in terms of adrenocorticotropic hormone (ACTH) and overnight 1 mg dexamethasone suppression test (DST) between the two groups (p > .05). There was no difference in SII between adenomas within the same patient, as well as between the unilateral and bilateral groups (p > .05). Logistic regression analysis based on the differentiation between unilateral and bilateral macronodular MACS demonstrated that DHEA‐S, HbA1c and LDL concentrations were associated factors.ConclusionDHEA‐S levels may not be as suppressed in patients with bilateral macronodular MACS as compared to those with unilateral adenoma. T2DM and hypercholesterolaemia have a higher frequency in bilateral patients. However, ACTH, overnight 1 mg DST and SII may not provide additional information for differentiation of bilaterality and unilaterality.

Publisher

Wiley

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