Context: Pituitary incidentalomas (PIs) are commonly encountered in clinical practice. The management of these asymptomatic pituitary lesions is still controversial. Systematic screening for subclinical or mild ACTH-dependent hypercortisolism (AH) is not presently recommended, due to the limited data available thus far on the epidemiological and clinical relevance of this condition in patients with PIs. As subclinical hypercortisolism (SH) was considered to be associated with chronic complications of overt cortisol excess, such as hypertension, diabetes, and osteoporosis, this disorder should be diagnosed at the early stage. Objective: The objective of this study was to evaluate the prevalence of hypercortisolism in a population of subjects with PIs. Design, subjects, and methods: A total of 68 consecutive patients (48 females and 20 males, aged 18-82 years) without clinically overt hypercortisolism, who were referred for evaluation of PIs between January 2010 and March 2013, were prospectively investigated for AH. Pituitary hypercortisolism was diagnosed in the presence of cortisol >50 nmol/l after 1 mg dexamethasone suppression test, non-suppressed ACTH, and the additional finding of one of the following: urinary free cortisol (UFC) >193 nmol/24 h, and midnight serum and salivary cortisol levels >207 and 2.8 nmol/l respectively. Results: Among patients with PIs, we found a 7.3% rate of pituitary hypercortisolism diagnosed with biochemical criteria and a 4.4% rate of histologically confirmed AH. Conclusions: Subclinical or mild hypercortisolism may be more common than generally perceived in patients with PIs.
Screening for ACTH-dependent hypercortisolism in patients affected with pituitary incidentaloma / A. Toini, A. Dolci, E. Ferrante, E. Verrua, E. Malchiodi, E. Sala, A.G. Lania, I. Chiodini, P. Beck-Peccoz, M. Arosio, A. Spada, G. Mantovani. - In: EUROPEAN JOURNAL OF ENDOCRINOLOGY. - ISSN 0804-4643. - 172:4(2015 Apr), pp. 363-369.
|Titolo:||Screening for ACTH-dependent hypercortisolism in patients affected with pituitary incidentaloma|
DOLCI, ALESSIA (Secondo)
SPADA, ANNAMARIA (Penultimo)
MANTOVANI, GIOVANNA (Ultimo)
|Parole Chiave:||ACTH-Secreting Pituitary Adenoma; Adenoma; Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Mass Screening; Middle Aged; Pituitary ACTH Hypersecretion; Young Adult; Incidental Findings; Endocrinology; Endocrinology, Diabetes and Metabolism; Medicine (all)|
|Settore Scientifico Disciplinare:||Settore MED/13 - Endocrinologia|
|Data di pubblicazione:||apr-2015|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1530/EJE-14-0599|
|Appare nelle tipologie:||01 - Articolo su periodico|