{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T02:25:27Z","timestamp":1787538327432,"version":"build-2736575974"},"reference-count":9,"publisher":"The Endocrine Society","issue":"9","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Low adrenocorticotropic hormone (ACTH) in a patient with an adrenal incidentaloma is usually attributed to ACTH-independent cortisol secretion. A 71-year-old woman with a 20-mm left adrenal mass had no cushingoid features. After a 1-mg dexamethasone suppression test, serum cortisol was 5.59\u2005\u03bcg\/dL (SI: 154\u2005nmol\/L) (cutoff, &amp;lt;1.8\u2005\u03bcg\/dL [SI: &amp;lt;50\u2005nmol\/L]), and ACTH was below 1.5\u2005pg\/mL (SI: below 0.33\u2005pmol\/L) (reference range, 7-63\u2005pg\/mL [SI: 1.5-13.9\u2005pmol\/L]). Late-night serum cortisol was 7.29\u2005\u03bcg\/dL (SI: 201\u2005nmol\/L) (cutoff, &amp;lt;5.0\u2005\u03bcg\/dL [SI: &amp;lt;138\u2005nmol\/L]), supporting mild autonomous cortisol secretion. Combined pituitary stimulation testing showed a blunted, delayed ACTH increase from 4.2 (SI: 0.92\u2005pmol\/L) to 11.8\u2005pg\/mL (SI: 60\u2005pmol\/L) without a cortisol response, whereas other anterior pituitary axes were preserved. A short Synacthen test showed an inadequate peak cortisol of 10.8\u2005\u03bcg\/dL (SI: 298\u2005nmol\/L) (adequacy cutoff, \u226518\u2005\u03bcg\/dL [SI: approximately 500\u2005nmol\/L]), and dehydroepiandrosterone sulfate was 37\u2005ng\/mL (SI: 0.10\u2005\u03bcmol\/L) (reference range, 70-495\u2005ng\/mL [SI: 0.19-1.34\u2005\u03bcmol\/L]). Possible isolated ACTH deficiency was diagnosed. Annual testing remained unchanged over 4 years.<\/jats:p>","DOI":"10.1210\/jcemcr\/luag229","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T11:47:35Z","timestamp":1785930455000},"source":"Crossref","is-referenced-by-count":0,"title":["Coexisting mild autonomous cortisol secretion and isolated adrenocorticotropic hormone deficiency in a patient with an adrenal incidentaloma"],"prefix":"10.1210","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-5672-5993","authenticated-orcid":false,"given":"Koki","family":"Ikeda","sequence":"first","affiliation":[{"name":"Department of Diabetes and Endocrinology, Juntendo University Urayasu Hospital , Chiba 279-0021 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4179-0175","authenticated-orcid":false,"given":"Shotaro","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Juntendo University Urayasu Hospital , Chiba 279-0021 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoki","family":"Sekine","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Juntendo University Urayasu Hospital , Chiba 279-0021 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Kadowaki","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Juntendo University Urayasu Hospital , Chiba 279-0021 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0943-0712","authenticated-orcid":false,"given":"Daisuke","family":"Sugimoto","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Juntendo University Urayasu Hospital , Chiba 279-0021 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0353-5807","authenticated-orcid":false,"given":"Hiroaki","family":"Satoh","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Juntendo University Urayasu Hospital , Chiba 279-0021 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"issue":"1","key":"2026082322025868100_luag229-B1","doi-asserted-by":"crossref","first-page":"G1","DOI":"10.1093\/ejendo\/lvad066","article-title":"European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors","volume":"189","author":"Fassnacht","year":"2023","journal-title":"Eur J 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