{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T23:17:13Z","timestamp":1778887033980,"version":"3.51.4"},"reference-count":39,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Horm Metab Res"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>To describe the differences in presentation, biochemistry, and radiological\n                    evaluation of various etiologies of adrenal Cushing\u2019s syndrome (CS) from\n                    a single center. To emphasize caution for interpretation of plasma\n                    adrenocorticotropic hormone (ACTH), as a spuriously unsuppressed ACTH level by\n                    immunometric assay may lead to therapeutic misadventures in adrenal CS.\n                    Design:\u2002Retrospective, single-center, observational study. Methods:\u2002 Fifty-eight\n                    adrenal CS patients [Adrenocortical carcinoma (ACC), n=30; Adenoma\n                    (ACA), n=15; Primary pigmented nodular adrenocortical disease (PPNAD),\n                    n=10; ACTH independent macronodular adrenal hyperplasia (AIMAH),\n                    n=3) evaluated at a tertiary care center in western India between\n                    January 2006 to March 2020 were included. Data on demography, clinical\n                    evaluation, biochemistry, imaging, management, histopathology, and outcome were\n                    recorded in a standard format and analyzed. Results:\u2002 Cortisol secreting ACC\n                    presented at 38(1\u201350) years with abdominal mass in 26\/30\n                    (86.7%) and 16\/30 (53.3%) had metastases at\n                    presentation. ACA with autonomous cortisol excess presented at\n                    25(4.9\u201340) years with discriminating features of CS in 14\/15\n                    (93.3%), sex steroid production in 2\/15, unenhanced HU\n                    &lt;10 in only one, and relative washout &gt;40% in\n                    8\/11 (72.7%). One ACA and eight ACC patients had plasma ACTH (by\n                    Siemens Immulite assay) &gt;\u200920\u2009pg\/ml, despite\n                    hypercortisolemic state. Conclusions:\u2002 Cortisol-secreting ACC and ACA most often\n                    present with mass effects and florid CS, respectively. Baseline HU has low\n                    sensitivity to differentiate cortisol-secreting ACA from ACC. Plasma ACTH\n                    measured by Seimens Immulite is often unsuppressed, especially in ACC patients,\n                    which can be addressed by measuring ACTH by more accurate assays.<\/jats:p>","DOI":"10.1055\/a-1735-3232","type":"journal-article","created":{"date-parts":[[2022,2,7]],"date-time":"2022-02-07T23:42:18Z","timestamp":1644277338000},"page":"57-66","source":"Crossref","is-referenced-by-count":2,"title":["Clinical Spectrum of Adrenal Cushing\u2019s Syndrome and the\n                    Caution for Interpretation of Adrenocorticotrophic Hormone: A Single-Center\n                    Experience"],"prefix":"10.1055","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5392-3066","authenticated-orcid":false,"given":"Vikrant","family":"Gosavi","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Seth G. S. Medical College and KEM\n                    Hospital, Mumbai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anurag","family":"Lila","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Seth G. S. Medical College and KEM\n                    Hospital, Mumbai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saba Samad","family":"Memon","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Seth G. S. Medical College and KEM\n                    Hospital, Mumbai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vijaya","family":"Sarathi","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Vydehi Institute of Medical Sciences and\n                    Research Centre, Bangalore, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kunal","family":"Thakkar","sequence":"additional","affiliation":[{"name":"Sterling Ramkrishna Speciality Hospital, Gandhidham,\n                    India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abhay","family":"Dalvi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Seth G. S. Medical College and KEM Hospital,\n                    Mumbai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaurav","family":"Malhotra","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Bhabha Atomic Research Centre, Mumbai,\n                    India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gagan","family":"Prakash","sequence":"additional","affiliation":[{"name":"Department of Uro-oncology, Tata Memorial Hospital, Mumbai,\n                    India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Virendra","family":"Patil","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Seth G. S. Medical College and KEM\n                    Hospital, Mumbai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nalini S.","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Seth G. S. Medical College and KEM\n                    Hospital, Mumbai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tushar","family":"Bandgar","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Seth G. S. Medical College and KEM\n                    Hospital, Mumbai, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,2,7]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1038\/nrendo.2016.24","article-title":"A genetic and molecular update on adrenocortical causes of Cushing syndrome","volume":"12","author":"M Lodish","year":"2016","journal-title":"Nat Rev Endocrinol"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1159\/000134829","article-title":"Cushing syndrome caused by adrenocortical tumors and hyperplasias\n                    (corticotropin-independent Cushing syndrome)","volume":"13","author":"C A Stratakis","year":"2008","journal-title":"Endocr Dev"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1210\/er.2013-1029","article-title":"Adrenocortical carcinoma","volume":"35","author":"T Else","year":"2014","journal-title":"Endocr Rev"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1111\/cen.12763","article-title":"An analysis of different therapeutic options in patients with Cushing\u2019s\n                    syndrome due to bilateral macronodular adrenal hyperplasia: a single-centre\n                    experience","volume":"82","author":"N M Albiger","year":"2015","journal-title":"Clin Endocrinol (Oxf)"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"726","DOI":"10.4158\/EP161721.RA","article-title":"AACE Adrenal Scientific Committee. An individualized approach to the evaluation\n                    of Cushing syndrome","volume":"23","author":"S T Sharma","year":"2017","journal-title":"Endocr Pract"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1016\/S0140-6736(14)61375-1","article-title":"Cushing\u2019s syndrome","volume":"386","author":"A Lacroix","year":"2015","journal-title":"Lancet"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"bcr2016217519","DOI":"10.1136\/bcr-2016-217519","article-title":"Adrenocortical carcinoma masquerading as Cushing\u2019s disease","author":"K D Jarial","year":"2017","journal-title":"BMJ Case Rep"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.clinbiochem.2018.11.006","article-title":"Corticotropin hormone assay interference: A case series","volume":"63","author":"D M Donegan","year":"2019","journal-title":"Clin Biochem"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1210\/js.2019-00027","article-title":"Assay-specific spurious ACTH results lead to misdiagnosis, unnecessary testing,\n                    and surgical misadventure \u2013 a case series","volume":"3","author":"L W Greene","year":"2019","journal-title":"J Endocr Soc"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1530\/EJE-16-0967","article-title":"Diagnostic tests for Cushing\u2019s syndrome differ from published\n                    guidelines: data from ERCUSYN","volume":"176","author":"E Valassi","year":"2017","journal-title":"Eur J Endocrinol"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1210\/jc.2008-0125","article-title":"The diagnosis of Cushing\u2019s syndrome: an endocrine society clinical\n                    practice guideline","volume":"93","author":"L K Nieman","year":"2008","journal-title":"J Clin Endocrinol Metab"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1530\/EC-19-0198","article-title":"Radiological differentiation of phaeochromocytoma from other malignant adrenal\n                    masses: importance of wash-in characteristics on multiphase CECT","volume":"8","author":"M Goroshi","year":"2019","journal-title":"Endocr Connect"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1515\/CCLM.2002.202","article-title":"Reference ranges for serum concentrations of lutropin (LH), follitropin (FSH),\n                    estradiol (E2), prolactin, progesterone, sex hormone-binding globulin (SHBG),\n                    dehydroepiandrosterone sulfate (DHEAS), cortisol and ferritin in neonates,\n                    children and young adults","volume":"40","author":"M W Elmlinger","year":"2002","journal-title":"Clin Chem Lab Med"},{"key":"ref14","volume-title":"Endocrine testing. In: Endocrinology: Adult and Pediatric","author":"J Nakamoto","year":"2016"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1515\/jpem-2018-0413","article-title":"Primary pigmented nodular adrenocortical disease (PPNAD): single centre\n                    experience","volume":"32","author":"S S Memon","year":"2019","journal-title":"J Pediatr Endocrinol Metab"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"99","DOI":"10.4103\/2230-8210.126586","article-title":"Etiology and clinical profile of patients with Cushing\u2019s syndrome: a\n                    single center experience","volume":"18","author":"A C Ammini","year":"2014","journal-title":"Indian J Endocrinol Metab"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"3566","DOI":"10.1210\/jc.2018-00918","article-title":"Predictors of survival in adrenocortical carcinoma: an analysis from the\n                    national cancer database","volume":"103","author":"S H Tella","year":"2018","journal-title":"J Clin Endocrinol Metab"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1530\/EJE-13-0519","article-title":"Adrenocortical carcinoma: clinical outcomes and prognosis of 330 patients at a\n                    tertiary care center","volume":"169","author":"M Ayala-Ramirez","year":"2013","journal-title":"Eur J Endocrinol"},{"key":"ref19","first-page":"1099","article-title":"Androgen-secreting adrenal adenomas","volume":"100","author":"K Danilowicz","year":"2002","journal-title":"Obstet Gynecol"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"332","DOI":"10.4103\/2230-8210.152764","article-title":"Feminizing adrenocortical tumors: literature review","volume":"19","author":"F Chentli","year":"2015","journal-title":"Indian J Endocrinol Metab"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"2637","DOI":"10.1210\/jc.2014-1401","article-title":"Adrenal function after adrenalectomy for subclinical hypercortisolism and\n                    Cushing\u2019s syndrome: a systematic review of the literature","volume":"99","author":"G Di Dalmazi","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"201","DOI":"10.2214\/ajr.171.1.9648789","article-title":"Characterization of adrenal masses using unenhanced CT: an analysis of the CT\n                    literature","volume":"171","author":"G W Boland","year":"1998","journal-title":"AJR Am J Roentgenol"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1007\/s12020-018-1522-7","article-title":"The computed tomography adrenal wash-out analysis properly classifies cortisol\n                    secreting adrenocortical adenomas","volume":"59","author":"A-L Humbert","year":"2018","journal-title":"Endocrine"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1530\/EJE-15-0036","article-title":"The 10 Hounsfield units unenhanced computed tomography attenuation threshold\n                    does not apply to cortisol secreting adrenocortical adenomas","volume":"173","author":"C Chambre","year":"2015","journal-title":"Eur J Endocrinol"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.2147\/OTT.S81831","article-title":"Clinical and pathological analysis of 116 cases of adult adrenal cortical\n                    adenoma and literature review","volume":"8","author":"A-H Jia","year":"2015","journal-title":"Onco Targets Ther"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1530\/EJE-14-0916","article-title":"Computed tomography criteria for discrimination of adrenal adenomas and\n                    adrenocortical carcinomas: analysis of the German ACC registry","volume":"172","author":"S Petersenn","year":"2015","journal-title":"Eur J Endocrinol"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1148\/radiol.10091386","article-title":"Incidental adrenal lesions: accuracy of characterization with contrast-enhanced\n                    washout multidetector CT-10-minute delayed imaging protocol revisited in a large\n                    patient cohort","volume":"256","author":"M J Sangwaiya","year":"2010","journal-title":"Radiology"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"1448","DOI":"10.1210\/clinem\/dgab005","article-title":"18F-FDG-PET\/CT Evaluation of indeterminate adrenal masses in noncancer\n                    patients","volume":"106","author":"X He","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1016\/j.beem.2013.05.011","article-title":"Heterophilic antibody interference in immunometric assays","volume":"27","author":"N Bolstad","year":"2013","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1007\/s12020-017-1268-7","article-title":"Interference in ACTH immunoassay negatively impacts the management of\n                    subclinical hypercortisolism","volume":"56","author":"S Yener","year":"2017","journal-title":"Endocrine"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1177\/0004563213487514","article-title":"A diagnostic conundrum: heterophilic antibody interference in an\n                    adrenocorticotropic hormone immunoassay not detectable using a proprietary\n                    heterophile blocking reagent","volume":"50","author":"J Grasko","year":"2013","journal-title":"Ann Clin Biochem"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1007\/s12291-018-0770-x","article-title":"Heterophile antibody to adrenocorticotropin hormone interfering with the\n                    investigation of Cushing\u2019s syndrome","volume":"34","author":"A Morton","year":"2019","journal-title":"Indian J Clin Biochem"},{"key":"ref33","first-page":"440","article-title":"Diagnosis and management of Cushing\u2019s syndrome: results of an Italian\n                    multicentre study. Study group of the Italian society of endocrinology on the\n                    pathophysiology of the hypothalamic-pituitary-adrenal axis","volume":"84","author":"C Invitti","year":"1999","journal-title":"J Clin Endocrinol Metab"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1530\/EJE-10-0962","article-title":"Assessment of ACTH assay variability: a multicenter study","volume":"164","author":"F Pecori Giraldi","year":"2011","journal-title":"Eur J Endocrinol"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1373\/clinchem.2019.306365","article-title":"An intact ACTH LC-MS\/MS assay as an arbiter of clinically discordant\n                    immunoassay results","volume":"65","author":"J Shi","year":"2019","journal-title":"Clin Chem"},{"key":"ref36","doi-asserted-by":"crossref","first-page":"1836","DOI":"10.1373\/clinchem.2017.277624","article-title":"A 13-tseroid serum panel based on LC-MS\/MS: use in detection of\n                    adrenocortical carcinoma","volume":"63","author":"D R Taylor","year":"2017","journal-title":"Clin Chem"},{"key":"ref37","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1210\/jcem-73-4-752","article-title":"Elevated plasma adrenocorticotropin (ACTH) with adrenal hyperplasia: a new\n                    factor in ACTH regulation?","volume":"73","author":"A A Ismail","year":"1991","journal-title":"J Clin Endocrinol Metab"},{"key":"ref38","doi-asserted-by":"crossref","first-page":"2115","DOI":"10.1056\/NEJMoa1215245","article-title":"Intraadrenal corticotropin in bilateral macronodular adrenal hyperplasia","volume":"369","author":"E Louiset","year":"2013","journal-title":"N Engl J Med"},{"key":"ref39","doi-asserted-by":"crossref","first-page":"bcr2016216965","DOI":"10.1136\/bcr-2016-216965","article-title":"Adrenal Cushing syndrome with detectable ACTH from an unexpected source","volume":"2016","author":"T M Lwin","year":"2016","journal-title":"BMJ Case Rep"}],"container-title":["Hormone and Metabolic Research"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1735-3232.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,7]],"date-time":"2022-02-07T23:42:43Z","timestamp":1644277363000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1735-3232"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2]]},"references-count":39,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2022,2,7]]},"published-print":{"date-parts":[[2022,2]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1735-3232","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0018-5043","1439-4286"],"issn-type":[{"value":"0018-5043","type":"print"},{"value":"1439-4286","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2]]}}}