Contralateral adrenal suppression on adrenocortical scintigraphy provides good evidence showing subclinical cortisol overproduction from unilateral adenomas

Endocrine journal

Shiko Asai¹  Takuyuki Katabami¹  Satoshi Ishii²  Ryusei Obi²  Yasushi Tanaka² 

[1] Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan;Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan

关键词: Adrenocortical scintigraphy;    Subclinical Cushing’    s syndrome;    Adrenal incidentaloma;   

DOI  :  10.1507/endocrj.EJ16-0281

学科分类：内分泌与代谢学

来源: Japan Endocrine Society

【 摘 要 】

Unilateral and/or predominant uptake on adrenocortical scintigraphy (ACS) may be related to autonomous cortisol overproduction in patients with subclinical Cushing’s syndrome (SCS).However, there is no information regarding whether increased tracer uptake on the tumor side or decreased uptake on the contralateral side on ACS is more greatly associated with inappropriate cortisol production.Therefore, we evaluated the relationship between quantitative 131I-6β-iodomethyl-norcholesterol (131I-NP-59) uptake in both adrenal glands and parameters of autonomic cortisol secretion and attempted to set a cut off for SCS detection.The study included 90 patients with unilateral adrenal adenoma who fulfilled strict criteria.The diagnosis of SCS was based on serum cortisol ≥3.0 μg/dL after 1-mg dexamethasone suppression test (DST) with at least 1 other hypothalamus-pituitary-adrenal axis function abnormality.Twenty-two (27.7%) subjects were diagnosed with SCS.The uptake rate on the affected side in the SCS group was comparable to that in the non-functioning adenoma group.In contrast, the uptake rate on the contralateral side was lower and the laterality ratio significantly higher in the SCS group.The two ACS indices were correlated with serum cortisol levels after a 1-mg DST, but uptake on the tumor side was not.Tumor size was also important for the functional statuses of adrenal tumors and NP-59 imaging patterns.The best cut-off point for the laterality ratio to detect SCS was 3.07.These results clearly indicate that contralateral adrenal suppression in ACS is good evidence showing subclinical cortisol overproduction.

【 授权许可】

Unknown