Abstract
M Conall Dennedy, AK Annamalai, O Prankerd-Smith, N Freeman, et al. J Clin Endocrinol Metab 2017; 102: 786–792.
The term subclinical hypercortisolism (SH) is used to describe adrenocorticotrophin (ACTH)-independent cortisol secretion from a benign adrenal adenoma not associated with clinically overt hypercortisolism. Dehydroepiandrosterone sulphate (DHEAS) is regulated by pituitary ACTH; sustained suppression of central ACTH, as seen in SH, leads to a reduction in DHEAS implying that DHEAS could be used as a diagnostic test for SH in patients with adrenal incidentaloma (AI).
The authors describe a retrospective study of patients referred for the investigation of AI. Patients were assessed using a standardized protocol including DHEAS, and a diagnosis of SH was made according to the Endocrine Society Clinical Practice Guideline (2008).
DHEAS differentiated well between SH and non-functioning adenoma, with receiver operating characteristic analysis giving an area under the curve (AUC) of 0.95. DHEAS also distinguished SH from all other non-SH adrenal lesions within the cohort with an AUC of 0.97. The authors conclude that DHEAS would be an effective screening test for SH in patients with AI.