{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T08:06:10Z","timestamp":1791533170480,"version":"4.3.4"},"reference-count":30,"publisher":"The Endocrine Society","issue":"11","funder":[{"DOI":"10.13039\/501100009879","name":"Regione Emilia-Romagna","doi-asserted-by":"publisher","award":["PRUa1a-2007-006"],"award-info":[{"award-number":["PRUa1a-2007-006"]}],"id":[{"id":"10.13039\/501100009879","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009879","name":"Regione Emilia-Romagna","doi-asserted-by":"publisher","award":["PRUA 1-2012-004"],"award-info":[{"award-number":["PRUA 1-2012-004"]}],"id":[{"id":"10.13039\/501100009879","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Context<\/jats:title>\n                  <jats:p>Steroid profiling by mass spectrometry has shown implications for diagnosis and subtyping of adrenal tumors.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To investigate steroid profiles and their cardiovascular correlates in a large cohort of patients with nonsecreting (NS) adrenal incidentalomas and autonomous cortisol secretion (ACS).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Cohort study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>University hospital.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Patients<\/jats:title>\n                  <jats:p>Patients (n = 302) with incidentally discovered adrenal masses, divided into unilateral adenoma and hyperplasia with ACS (n = 46 and n = 52, respectively) and NS (n = 120 and n = 84, respectively). Post\u2013dexamethasone suppression test (DST) cortisol &lt;50 or &gt;50 nmol\/L defined NS and ACS, respectively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Intervention<\/jats:title>\n                  <jats:p>Analysis of 10-steroid panel by liquid chromatography\u2013tandem mass spectrometry (LC-MS\/MS) and clinical data (mean follow-up 39 months).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main Outcome Measures<\/jats:title>\n                  <jats:p>Difference in baseline and post-DST steroid profiles between groups. Correlation with cardiovascular profile.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Patients with unilateral adenomas and ACS showed higher cortisol, 11-deoxycortisol, and corticosterone and lower dehydroepiandrosterone than those with NS adenomas. Patients with ACS hyperplasia showed higher cortisol and lower androgens in women than those with NS. Patients with ACS had reduced suppression of post-DST cortisol, 11-deoxycortisol, and corticosterone, irrespective of adrenal morphology. Post-DST cortisol and corticosterone were associated with higher prevalence of severe\/resistant hypertension. Patients with ACS unilateral adenomas showed higher incidence of worsening of hypertensive disease and novel cardiovascular events than those with NS, with post-DST cortisol [hazard ratio (HR) 1.02; 95% CI, 1.01 to 1.03; P &lt; 0.001] and baseline corticosterone (HR 1.06; 95% CI, 1.01 to 1.12; P = 0.031) among the main predictors.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Patients with adrenal incidentalomas showed different steroid profiles, depending on functional status and adrenal morphology, with implications for their cardiovascular status.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/jc.2019-00365","type":"journal-article","created":{"date-parts":[[2019,8,7]],"date-time":"2019-08-07T14:45:05Z","timestamp":1565189105000},"page":"5519-5528","source":"Crossref","is-referenced-by-count":42,"title":["The Steroid Profile of Adrenal Incidentalomas: Subtyping Subjects With High Cardiovascular Risk"],"prefix":"10.1210","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1291-8906","authenticated-orcid":false,"given":"Guido","family":"Di Dalmazi","sequence":"first","affiliation":[{"name":"Endocrinology Unit and Centre for Applied Biomedical Research, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flaminia","family":"Fanelli","sequence":"additional","affiliation":[{"name":"Endocrinology Unit and Centre for Applied Biomedical Research, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Zavatta","sequence":"additional","affiliation":[{"name":"Endocrinology Unit and Centre for Applied Biomedical Research, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Ricci Bitti","sequence":"additional","affiliation":[{"name":"Endocrinology Unit and Centre for Applied Biomedical Research, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Mezzullo","sequence":"additional","affiliation":[{"name":"Endocrinology Unit and Centre for Applied Biomedical Research, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Repaci","sequence":"additional","affiliation":[{"name":"Endocrinology Unit and Centre for Applied Biomedical Research, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Pelusi","sequence":"additional","affiliation":[{"name":"Endocrinology Unit and Centre for Applied Biomedical Research, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Gambineri","sequence":"additional","affiliation":[{"name":"Endocrinology Unit and Centre for Applied Biomedical Research, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Altieri","sequence":"additional","affiliation":[{"name":"Endocrinology Unit and Centre for Applied Biomedical Research, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Mosconi","sequence":"additional","affiliation":[{"name":"Diagnostic and Interventional Radiology Unit, Department of Diagnostic and Preventive Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Balacchi","sequence":"additional","affiliation":[{"name":"Diagnostic and Interventional Radiology Unit, Department of Diagnostic and Preventive Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Golfieri","sequence":"additional","affiliation":[{"name":"Diagnostic and Interventional Radiology Unit, Department of Diagnostic and Preventive Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugenio Roberto","family":"Cosentino","sequence":"additional","affiliation":[{"name":"Hypertension Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Borghi","sequence":"additional","affiliation":[{"name":"Hypertension Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Vicennati","sequence":"additional","affiliation":[{"name":"Endocrinology Unit and Centre for Applied Biomedical Research, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renato","family":"Pasquali","sequence":"additional","affiliation":[{"name":"Endocrinology Unit and Centre for Applied Biomedical Research, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uberto","family":"Pagotto","sequence":"additional","affiliation":[{"name":"Endocrinology Unit and Centre for Applied Biomedical Research, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2019,8,5]]},"reference":[{"issue":"4","key":"2019100709583685800_bib1","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1007\/BF03344099","article-title":"Prevalence of adrenal incidentaloma in a contemporary computerized tomography series","volume":"29","author":"Bovio","year":"2006","journal-title":"J Endocrinol Invest"},{"issue":"8","key":"2019100709583685800_bib2","doi-asserted-by":"crossref","first-page":"2637","DOI":"10.1210\/jc.2014-1401","article-title":"Adrenal function after adrenalectomy for subclinical hypercortisolism and Cushing\u2019s syndrome: a systematic review of the literature","volume":"99","author":"Di Dalmazi","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"issue":"2","key":"2019100709583685800_bib3","doi-asserted-by":"crossref","first-page":"G1","DOI":"10.1530\/EJE-16-0467","article-title":"Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors","volume":"175","author":"Fassnacht","year":"2016","journal-title":"Eur J Endocrinol"},{"issue":"5","key":"2019100709583685800_bib4","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/S2213-8587(13)70211-0","article-title":"Cardiovascular events and mortality in patients with adrenal incidentalomas that are either non-secreting or associated with intermediate phenotype or subclinical Cushing\u2019s syndrome: a 15-year retrospective study","volume":"2","author":"Di Dalmazi","year":"2014","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"12","key":"2019100709583685800_bib5","doi-asserted-by":"crossref","first-page":"4462","DOI":"10.1210\/jc.2014-3007","article-title":"Cortisol as a marker for increased mortality in patients with incidental adrenocortical adenomas","volume":"99","author":"Debono","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"issue":"3","key":"2019100709583685800_bib6","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1210\/jc.2013-3527","article-title":"Long-term follow-up in adrenal incidentalomas: an Italian multicenter study","volume":"99","author":"Morelli","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"issue":"2","key":"2019100709583685800_bib7","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1007\/s12020-017-1400-8","article-title":"Increased mortality in patients with adrenal incidentalomas and autonomous cortisol secretion: a 13-year retrospective study from one center","volume":"58","author":"Patrova","year":"2017","journal-title":"Endocrine"},{"issue":"12","key":"2019100709583685800_bib8","doi-asserted-by":"crossref","first-page":"3775","DOI":"10.1210\/jc.2011-1565","article-title":"Urine steroid metabolomics as a biomarker tool for detecting malignancy in adrenal tumors","volume":"96","author":"Arlt","year":"2011","journal-title":"J Clin Endocrinol Metab"},{"issue":"5\u20136","key":"2019100709583685800_bib9","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1007\/s12672-016-0267-0","article-title":"Different types of urinary steroid profiling obtained by high-performance liquid chromatography and gas chromatography\u2013mass spectrometry in patients with adrenocortical carcinoma","volume":"7","author":"Velikanova","year":"2016","journal-title":"Horm Cancer"},{"issue":"4","key":"2019100709583685800_bib10","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1007\/s12672-015-0224-3","article-title":"Diagnostic value of urinary steroid profiling in the evaluation of adrenal tumors","volume":"6","author":"Kerkhofs","year":"2015","journal-title":"Horm Cancer"},{"issue":"3","key":"2019100709583685800_bib11","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1373\/clinchem.2017.282582","article-title":"Plasma steroid metabolome profiling for diagnosis and subtyping patients with Cushing syndrome","volume":"64","author":"Eisenhofer","year":"2018","journal-title":"Clin Chem"},{"issue":"9","key":"2019100709583685800_bib12","doi-asserted-by":"crossref","first-page":"3529","DOI":"10.1210\/JC.2015-1992","article-title":"Steroid profiling by LC-MS\/MS in nonsecreting and subclinical cortisol-secreting adrenocortical adenomas","volume":"100","author":"Di Dalmazi","year":"2015","journal-title":"J Clin Endocrinol Metab"},{"issue":"7","key":"2019100709583685800_bib13","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/S0009-9260(05)81739-8","article-title":"The size of normal adrenal glands on computed tomography","volume":"49","author":"Vincent","year":"1994","journal-title":"Clin Radiol"},{"issue":"11","key":"2019100709583685800_bib14","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1016\/j.acra.2014.06.008","article-title":"Linear and volumetric evaluation of the adrenal gland\u2014MDCT-based measurements of the adrenals","volume":"21","author":"Schneller","year":"2014","journal-title":"Acad Radiol"},{"key":"2019100709583685800_bib15","unstructured":"Di Dalmazi\n              G\n            , FanelliF, ZavattaG, Ricci BittiS, MezzulloM, RepaciA, PelusiC, GambineriA, AltieriP, MosconiC, BalacchiC, GolfieriR, CosentinoER, BorghiC, VicennatiV, PasqualiR, PagottoU. Data from: The steroid profile of adrenal incidentalomas: subtyping subjects with high cardiovascular risk. figshare 2019. Deposited 9 April 2019. https:\/\/figshare.com\/s\/201266e34ca5a1538b17."},{"issue":"9","key":"2019100709583685800_bib16","doi-asserted-by":"crossref","first-page":"1751","DOI":"10.1097\/HJH.0b013e3282f0580f","article-title":"2007 ESH-ESC practice guidelines for the management of arterial hypertension: ESH-ESC Task Force on the Management of Arterial Hypertension","volume":"25","author":"Mancia","year":"2007","journal-title":"J Hypertens"},{"issue":"6","key":"2019100709583685800_bib17","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1161\/HYPERTENSIONAHA.108.189141","article-title":"Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research","volume":"51","author":"Calhoun","year":"2008","journal-title":"Hypertension"},{"key":"2019100709583685800_bib18","doi-asserted-by":"crossref","first-page":"S62","DOI":"10.2337\/dc10-S062","article-title":"Diagnosis and classification of diabetes mellitus","volume":"33","author":"American Diabetes Association","year":"2010","journal-title":"Diabetes Care"},{"issue":"19","key":"2019100709583685800_bib19","doi-asserted-by":"crossref","first-page":"2486","DOI":"10.1001\/jama.285.19.2486","article-title":"Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)","volume":"285","author":"Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults","year":"2001","journal-title":"JAMA"},{"issue":"3","key":"2019100709583685800_bib20","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.steroids.2010.11.005","article-title":"Serum steroid profiling by isotopic dilution-liquid chromatography-mass spectrometry: comparison with current immunoassays and reference intervals in healthy adults","volume":"76","author":"Fanelli","year":"2011","journal-title":"Steroids"},{"issue":"5-6","key":"2019100709583685800_bib21","first-page":"192","article-title":"Coexistence of 21-hydroxylase and 11 beta-hydroxylase deficiency in adrenal incidentalomas and in subclinical Cushing\u2019s syndrome","volume":"57","author":"Dall\u2019Asta","year":"2002","journal-title":"Horm Res"},{"issue":"6","key":"2019100709583685800_bib22","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1530\/EJE-16-0689","article-title":"Persistence of myopathy in Cushing\u2019s syndrome: evaluation of the German Cushing\u2019s Registry","volume":"176","author":"Berr","year":"2017","journal-title":"Eur J Endocrinol"},{"issue":"2","key":"2019100709583685800_bib23","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1111\/cen.13512","article-title":"Impact of hypercortisolism on skeletal muscle mass and adipose tissue mass in patients with adrenal adenomas","volume":"88","author":"Delivanis","year":"2018","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"2","key":"2019100709583685800_bib24","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1530\/EJE-17-0109","article-title":"Cortisol-related metabolic alterations assessed by mass spectrometry assay in patients with Cushing\u2019s syndrome","volume":"177","author":"Di Dalmazi","year":"2017","journal-title":"Eur J Endocrinol"},{"issue":"6","key":"2019100709583685800_bib25","doi-asserted-by":"crossref","first-page":"R249","DOI":"10.1530\/EJE-15-1118","article-title":"Endocrine tumours: the genomics of adrenocortical tumors","volume":"174","author":"Faillot","year":"2016","journal-title":"Eur J Endocrinol"},{"issue":"352","key":"2019100709583685800_bib26","doi-asserted-by":"crossref","first-page":"352ra109","DOI":"10.1126\/scitranslmed.aaf9074","article-title":"ABCC1 confers tissue-specific sensitivity to cortisol versus corticosterone: a rationale for safer glucocorticoid replacement therapy","volume":"8","author":"Nixon","year":"2016","journal-title":"Sci Transl Med"},{"issue":"4812","key":"2019100709583685800_bib27","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1126\/science.3037703","article-title":"Cloning of human mineralocorticoid receptor complementary DNA: structural and functional kinship with the glucocorticoid receptor","volume":"237","author":"Arriza","year":"1987","journal-title":"Science"},{"issue":"2","key":"2019100709583685800_bib28","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.mce.2011.05.005","article-title":"Central regulation of blood pressure by the mineralocorticoid receptor","volume":"350","author":"Gomez-Sanchez","year":"2012","journal-title":"Mol Cell Endocrinol"},{"issue":"6","key":"2019100709583685800_bib29","doi-asserted-by":"crossref","first-page":"2686","DOI":"10.1210\/endo.142.6.8213","article-title":"Multidrug resistance P-glycoprotein hampers the access of cortisol but not of corticosterone to mouse and human brain","volume":"142","author":"Karssen","year":"2001","journal-title":"Endocrinology"},{"issue":"2","key":"2019100709583685800_bib30","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1007\/s12020-015-0776-6","article-title":"Subclinical Cushing\u2019s syndrome in patients with bilateral compared to unilateral adrenal incidentalomas: a systematic review and meta-analysis","volume":"51","author":"Paschou","year":"2016","journal-title":"Endocrine"}],"container-title":["The Journal of Clinical Endocrinology &amp; Metabolism"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jcem\/advance-article-pdf\/doi\/10.1210\/jc.2019-00365\/29091669\/jc.2019-00365.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jcem\/article-pdf\/104\/11\/5519\/30111853\/jc.2019-00365.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jcem\/article-pdf\/104\/11\/5519\/30111853\/jc.2019-00365.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,10,7]],"date-time":"2019-10-07T09:59:24Z","timestamp":1570442364000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcem\/article\/104\/11\/5519\/5542836"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,5]]},"references-count":30,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2019,11,1]]}},"URL":"https:\/\/doi.org\/10.1210\/jc.2019-00365","relation":{},"ISSN":["0021-972X","1945-7197"],"issn-type":[{"value":"0021-972X","type":"print"},{"value":"1945-7197","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,11]]},"published":{"date-parts":[[2019,8,5]]}}}