Hipercortisolismo subclínico cíclico : uma forma de hipersecreção previamente não identificada dos Incidentalomas de Adrenal

• Ano de defesa: 2019
• Autor(a) principal: Giorgi, Rafael Buck [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Hipercortisolismo; Subclínico Cíclico
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=7756555; https://repositorio.unifesp.br/handle/11600/59397

Purpose: Most adrenal incidentalomas (AI) are non-functioning adenomas (NFA), but up to 30% may secrete cortisol autonomously without clinical evidence of Cushing’s syndrome (CS) that nevertheless may increase cardiovascular mortality. This subclinical hypercortisolism (SCH) is confirmed by cortisol resistance to a dexamethasone suppression test (DST). Cyclic cortisol secretion occurs in classic CS but was not reported in SCH. Objective: Investigate cyclic cortisol production/autonomy in AI using sequential DST. Methods: 251 AI patients underwent 487 DST along 12 years; patients with at least 3 (3+) DST were selected. DSTs were validated by measuring serum dexamethasone. Cyclic SCH was defined when at least 2 abnormal and 2 normal DST were documented. Results: 44 patients had 3+ DST during follow-up: 9/44 patients (20.4%) had all tests negative (post-DST cortisol ≤1.8g/dL) being classified as NFA; another 9 had all tests positive (cortisol >1.8g/dL) and were grouped as sustained SCH. The remaining 26 (59.2%) had discordant responses: 8/44 (18.3%) had at least 2 positive and 2 negative tests, matching the criterion for cyclic SCH, whereas 18/44 (40.9%) had only one discordant test, being considered possibly cyclic SCH. Eleven of 20 (55%) patients initially diagnosed as NFA did not maintain their cortisol pattern subsequently. Conclusions: Extended follow-up with repeated DST uncovered an unusual subset of AI with cyclic SCH. Recurring production of cortisol may puzzle investigation of AI subtypes if based on just one DST. Lack of recognition of this phenomenon makes followup of AI patients misleading, since even cyclic SCH may result in potential CV risk.