{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:46:05Z","timestamp":1790696765954,"version":"4.1.0"},"reference-count":38,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,3,2]],"date-time":"2021-03-02T00:00:00Z","timestamp":1614643200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["AG 28168"],"award-info":[{"award-number":["AG 28168"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Describe the secretion and profile of adrenal steroids in patients with adrenal incidentalomas compared to control subjects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting and Participants<\/jats:title><jats:p>A prospective study, 73 patients with adrenal incidentalomas, 21 bilateral and 52 unilateral and 34 matched controls in University Hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Collect fasting blood sample before and 60\u00a0min after ACTH test (250\u00a0\u00b5g IV). One week later, perform overnight 1\u00a0mg dexamethasone test. The following steroids were measured by liquid chromatography\u2010mass spectrometry (LC\u2010MS): pregnenolone, 17\u2010OH pregnenolone, 17\u2010OH progesterone, 11\u2010deoxycorticosterone, 11\u2010deoxyortisol, 21\u2010deoxycortisol, corticosterone, cortisol, androstenedione and aldosterone.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Mean baseline serum cortisol was higher in incidentalomas, bilateral 361\u00a0\u00b1\u00a0124, (range 143\u2013665)\u00a0nmol\/L,(<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.0001), unilateral 268\u00a0\u00b1\u00a089 3.2 (range 98\u2013507)\u00a0nmol\/L (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.019) compared to controls 207\u00a0\u00b1\u00a0100 (range 72\u2013502)\u00a0nmol\/L. ACTH stimulation showed significantly higher levels in bilateral and unilateral cases compared to controls. After dexamethasone, mean serum cortisol levels suppressed in bilaterals 89\u00a0\u00b1\u00a069 (range 30\u20133)\u00a0nmol\/L (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.0001), 58\u00a0\u00b1\u00a052 (range 16\u2013323)\u00a0nmol\/L in unilateral (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.01) compared to 26\u00a0\u00b1\u00a09 (range 7\u201346)\u00a0nmol\/L in controls. Mean baseline serum corticosterone was higher in bilateral 9.3\u00a0\u00b1\u00a04.8 (range 2.4\u201318.4)\u00a0nmol\/L (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.005) and unilateral 7.3\u00a0\u00b1\u00a05.7 (range 0.1\u201330.3)\u00a0nmol\/L (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.01) compared to controls 4.2\u00a0\u00b1\u00a02.4 (range 1.1\u201310.2)\u00a0nmol\/L, after ACTH stimulation significantly increased to higher levels in bilateral (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.0002) and unilateral cases (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.044) compared to controls. After dexamethasone, mean levels were 2.5\u00a0\u00b1\u00a02.6 (range 0.5\u201312.5)\u00a0nmol\/L in bilateral (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.0006), 1.5\u00a0\u00b1\u00a01.6 (range 0.3\u20139.3)\u00a0nmol\/L in unilateral (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.09) and 0.75\u00a0\u00b1\u00a00.46 (range 0.1\u20132.1)\u00a0nmol\/L in controls. Mean baseline serum 11\u2010deoxycorticosterone (DOC) was higher in bilaterals 0.32\u00a0\u00b1\u00a00.23 (range 0.08\u20131.1)\u00a0nmol\/L (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.03) compared to controls 0.15\u00a0\u00b1\u00a00.21 (range 0.08\u20131.1)\u00a0nmol\/L. ACTH stimulation increased levels to 3.27\u00a0\u00b1\u00a01.72 (range 0.5\u20137.4)\u00a0nmol\/L in bilateral cases compared to controls 1.369\u00a0\u00b1\u00a01.53 (range 0.1\u20137.1)\u00a0nmol\/L (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.0001). Dexamethasone decreased levels to baseline (<jats:italic>p<\/jats:italic> ns). There were significant differences in serum 21\u2010deoxycortisol (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.0002) and serum pregnenolone (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.004) only after ACTH stimulation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There is increased activity in several steroid biosynthesis pathways and higher steroid levels in bilateral compared to unilateral cases and evidence of hypercortisolism in 30% unilateral and 62% of bilateral incidentalomas.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.14445","type":"journal-article","created":{"date-parts":[[2021,2,18]],"date-time":"2021-02-18T09:29:21Z","timestamp":1613640561000},"page":"29-40","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Steroidogenesis in patients with adrenal incidentalomas: Extended steroid profile measured by liquid chromatography\u2010mass spectrometry after ACTH stimulation and dexamethasone suppression"],"prefix":"10.1111","volume":"95","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1042-5083","authenticated-orcid":false,"given":"Martha K. 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