Incidentaloma laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Laboratory findings consistent with the diagnosis of incidentaloma include an abnormal 1 mg overnight dexamethasone for subclinical Cushing's syndrome that should be confirmed with 24-hour urinary free cortisol, serum ACTH concentration, and dehydroepiandrosterone sulfate (DHEAS). In patients with adrenal masses that have a probability for pheochromocytoma, routine measurement of 24-hour urinary fractionated metanephrines and catecholamines should be done. All patients with hypertension and an adrenal incidentaloma should be evaluated by measurements of plasma aldosterone concentration and plasma renin activity.

Laboratory Findings

Subclinical Cushing's syndrome

• Subclinical Cushing's syndrome should be ruled out by performing the 1 mg overnight dexamethasone suppression test (DST).
• An abnormal 1 mg overnight dexamethasone should be confirmed with 24-hour urinary free cortisol, serum ACTH concentration, and dehydroepiandrosterone sulfate (DHEAS).

• An undetectable level of serum ACTH is also supportive of the diagnosis of subclinical Cushing’s syndrome.

• Hormonal evaluation in the patients with subclinical Cushing's syndrome showed the following [11]:

• Low baseline secretion of ACTH
• Lack of suppressibility of cortisol secretion after 1 mg dexamethasone
• Supranormal 24-hour urinary cortisol excretion
• Disturbed cortisol circadian rhythm
• Blunted plasma ACTH responses to corticotropin-releasing hormone (CRH)

Pheochromocytoma

In patients with adrenal masses that have a probability for pheochromocytoma, routine measurement of 24-hour urinary fractionated metanephrines and catecholamines should be done.

Aldosteronomas

All patients with hypertension and an adrenal incidentaloma should be evaluated by measurements of plasma aldosterone concentration and plasma renin activity.