J Endocrinol Metab

Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc

Journal website http://www.jofem.org

Original Article

Volume 8, Number 4, August 2018, pages 62-68

Screening Tests for Hypercortisolism in Patients With Adrenal Incidentaloma

**Table 1.** Clinical and Biochemical Characteristics of Patients With Adrenal Incidentaloma
	Unilateral adenoma	Bilateral adenoma	P
^aNormally distributed data are presented by mean and SD; ^bNon-normally distributed data are presented by median and range; ^cCoronary disease, previous stroke or peripheral artery disease. *P < 0.05 indicates statistically significant difference between unilateral and bilateral adenoma.
Age (years)^a	66.9 ± 13.9	63.5 ± 8.0	0.406
Gender (N, % female)	45/63 (71.4%)	7/20 (35.0%)	< 0.001*
Adrenal mass size (mm)^b	20 (8 - 45)	22 (10 - 53)	0.693
Cortisol after 1-mg DST (μg/dL)	1.6 (0.4 - 7.0)	1.4 (0.6 - 2.3)	0.216
LNSC (μg/dL)^b	0.206 (0.005 - 1.140)	0.296 (0.050 - 0.621)	0.019*
UFC (nmol/24 h)^b	28.3 (4.4 - 130.0)	48.0 (10.4 - 119.0)	0.192
BMI^b	27.0 (20.3 - 42.4)	27.4 (21.2 - 33.0)	0.852
Obesity (BMI ≥ 30) (N, %)	18/61 (29.5%)	5/19 (26.3%)	0.503
Hypertension (N, %)	46/63 (73.0%)	14/20 (70.0%)	0.501
Diabetes mellitus (N, %)	36/63 (57.1%)	11/20 (55.0%)	0.534
Dyslipidemia (N, %)	20/63 (31.7%)	5/20 (25.0%)	0.392
Cardiovascular disease^c (N, %)	8/49 (16.3%)	3/14 (21.4%)	0.658

Table 1. Clinical and Biochemical Characteristics of Patients With Adrenal Incidentaloma

Unilateral adenoma

Bilateral adenoma

^aNormally distributed data are presented by mean and SD; ^bNon-normally distributed data are presented by median and range; ^cCoronary disease, previous stroke or peripheral artery disease. *P < 0.05 indicates statistically significant difference between unilateral and bilateral adenoma.

Age (years)^a

66.9 ± 13.9

63.5 ± 8.0

0.406

Gender (N, % female)

45/63 (71.4%)

7/20 (35.0%)

< 0.001*

Adrenal mass size (mm)^b

20 (8 - 45)

22 (10 - 53)

0.693

Cortisol after 1-mg DST (μg/dL)

1.6 (0.4 - 7.0)

1.4 (0.6 - 2.3)

0.216

LNSC (μg/dL)^b

0.206 (0.005 - 1.140)

0.296 (0.050 - 0.621)

0.019*

UFC (nmol/24 h)^b

28.3 (4.4 - 130.0)

48.0 (10.4 - 119.0)

0.192

BMI^b

27.0 (20.3 - 42.4)

27.4 (21.2 - 33.0)

0.852

Obesity (BMI ≥ 30) (N, %)

18/61 (29.5%)

5/19 (26.3%)

0.503

Hypertension (N, %)

46/63 (73.0%)

14/20 (70.0%)

0.501

Diabetes mellitus (N, %)

36/63 (57.1%)

11/20 (55.0%)

0.534

Dyslipidemia (N, %)

20/63 (31.7%)

5/20 (25.0%)

0.392

Cardiovascular disease^c (N, %)

8/49 (16.3%)

3/14 (21.4%)

0.658

**Table 2.** Comparative Results of Screening Tests for Hypercortisolism Between Patients With AI and Cushing Syndrome
	Cutoff	Adrenal incidentaloma^a	Control group (Cushing syndrome)^a	P
^aData are presented in proportion and %. *P < 0.05 indicates statistically significant difference between adrenal incidentaloma and the control group.
1-mg DST	≤ 1.8 μg/dL	58/83 (69.9)	0	< 0.001*
	1.9 - 5.0 μg/dL	22/83 (26.5)	6/36 (16.7)
	> 5.0 μg/dL	3/83 (3.6)	30/36 (83.3)
LNSC	> 0.350 μg/dL	17/83 (20.5)	15/16 (93.8)	< 0.001*
UFC	> 172 nmol/24h	0	35/41 (85.4)	< 0.001*

Table 2. Comparative Results of Screening Tests for Hypercortisolism Between Patients With AI and Cushing Syndrome

Cutoff

Adrenal incidentaloma^a

Control group (Cushing syndrome)^a

^aData are presented in proportion and %. *P < 0.05 indicates statistically significant difference between adrenal incidentaloma and the control group.

1-mg DST

≤ 1.8 μg/dL

58/83 (69.9)

< 0.001*

1.9 - 5.0 μg/dL

22/83 (26.5)

6/36 (16.7)

> 5.0 μg/dL

3/83 (3.6)

30/36 (83.3)

LNSC

> 0.350 μg/dL

17/83 (20.5)

15/16 (93.8)

< 0.001*

UFC

> 172 nmol/24h

35/41 (85.4)

< 0.001*

**Table 3.** Prevalence of Cardiovascular Risk Factors and Cardiovascular Disease According to the Results on the 1-mg DST and LNSC Tests
Cutoff	1-mg DST	LNSC
^aNormally distributed data are presented by mean and SD; ^bNon-normally distributed data are presented by median and range; ^cCoronary disease, previous stroke or peripheral artery disease. *P < 0.05 indicates statistically significant difference between patients with morning cortisol levels after 1-mg DST ≤ 1.8, between 1.9 - 5.0 and > 5.0 μg/dL.
Hypertension (N, %)	38/58 (65.5%)	19/22 (86.4%)	3/3 (100%)	< 0.05*	48/66 (72.7%)	12/17 (70.6%)	0.540
Diabetes mellitus (N, %)	32/58 (55.2%)	13/22 (59.1%)	2/3 (66.7%)	0.643	39/66 (59.1%)	8/17 (47.1%)	0.267
Dyslipidemia (N, %)	13/58 (22.4%)	10/22 (45.5%)	2/3 (66.7%)	< 0.05*	19/66 (28.8%)	6/17 (35.3%)	0.402
BMI^b	27.5 (20.3 - 39.9)	28.7 (20.4 - 42.4)	26.6 (25.0 - 27.9)	0.563	28.0 (20.3 - 42.4)	26.9 (20.4 - 33.0)	0.504
Obesity (BMI ≥ 30) (N, %)	15/55 (27.3%)	8/22 (36.4%)	0/3 (0%)	0.932	18/64 (28.1%)	5/16 (31.3%)	0.514
Cardiovascular disease^c (N, %)	7/43 (16.3%)	2/18(11.1%)	2/2 (100%)	< 0.05*	9/52 (17.3%)	2/11 (17.5%)	0.619

Table 3. Prevalence of Cardiovascular Risk Factors and Cardiovascular Disease According to the Results on the 1-mg DST and LNSC Tests

Cutoff

1-mg DST

LNSC

≤ 1.8 μg/dL

1.9 - 5.0 μg/dL

> 5.0 μg/dL

≤ 0.350 μg/dL

> 0.350 μg/dL

Hypertension (N, %)

38/58 (65.5%)

19/22 (86.4%)

3/3 (100%)

< 0.05*

48/66 (72.7%)

12/17 (70.6%)

0.540

Diabetes mellitus (N, %)

32/58 (55.2%)

13/22 (59.1%)

2/3 (66.7%)

0.643

39/66 (59.1%)

8/17 (47.1%)

0.267

Dyslipidemia (N, %)

13/58 (22.4%)

10/22 (45.5%)

2/3 (66.7%)

< 0.05*

19/66 (28.8%)

6/17 (35.3%)

0.402

BMI^b

27.5 (20.3 - 39.9)

28.7 (20.4 - 42.4)

26.6 (25.0 - 27.9)

0.563

28.0 (20.3 - 42.4)

26.9 (20.4 - 33.0)

0.504

Obesity (BMI ≥ 30) (N, %)

15/55 (27.3%)

8/22 (36.4%)

0/3 (0%)

0.932

18/64 (28.1%)

5/16 (31.3%)

0.514

Cardiovascular disease^c (N, %)

7/43 (16.3%)

2/18(11.1%)

2/2 (100%)

< 0.05*

9/52 (17.3%)

2/11 (17.5%)

0.619

**Table 4.** Comparison of Demographic and Biochemical Characteristics Between Patients With Adrenal Incidentaloma and Cushing Syndrome
	Adrenal incidentaloma	Control group (Cushing syndrome)	P
^aNormally distributed data are presented by mean and SD; ^bNon-normally distributed data are presented by median and range. *P < 0.05 indicates statistically significant difference between adrenal incidentaloma and the control group.
Age (years)^a	66.2 ± 12.6	53.6 ± 16.0	< 0.001*
Gender (N, % female)	52 (62.7%)	38 (76.0%)	0.079
Cortisol after 1-mg DST (μg/dL)^b	1.5 (0.4 - 7.0)	8.5 (2.0 - 41.0)	< 0.001*
MSC (μg/dL)^b	0.512(0.005 - 1.430)	0.735 (0.266 - 2.21)	0.086
LNSC (μg/dL)^b	0.224(0.005 - 1.140)	0.779 (0.192 - 9.890)	< 0.001*
LNSC/MSC ratio^b	0.36 (0.49 - 4.23)	0.89 (0.49 - 1.92)	< 0.001*
UFC (nmol/24 h)^b	30.0 (4.4 - 130.0)	275.0 (42.5 – 5,241.0)	< 0.001*

Table 4. Comparison of Demographic and Biochemical Characteristics Between Patients With Adrenal Incidentaloma and Cushing Syndrome

Adrenal incidentaloma

Control group (Cushing syndrome)

^aNormally distributed data are presented by mean and SD; ^bNon-normally distributed data are presented by median and range. *P < 0.05 indicates statistically significant difference between adrenal incidentaloma and the control group.

Age (years)^a

66.2 ± 12.6

53.6 ± 16.0

< 0.001*

Gender (N, % female)

52 (62.7%)

38 (76.0%)

0.079

Cortisol after 1-mg DST (μg/dL)^b

1.5 (0.4 - 7.0)

8.5 (2.0 - 41.0)

< 0.001*

MSC (μg/dL)^b

0.512(0.005 - 1.430)

0.735 (0.266 - 2.21)

0.086

LNSC (μg/dL)^b

0.224(0.005 - 1.140)

0.779 (0.192 - 9.890)

< 0.001*

LNSC/MSC ratio^b

0.36 (0.49 - 4.23)

0.89 (0.49 - 1.92)

< 0.001*

UFC (nmol/24 h)^b

30.0 (4.4 - 130.0)

275.0 (42.5 – 5,241.0)

< 0.001*

**Table 5.** Performance of Screening Tests for Hypercortisolism in a Group of Patients With Adrenal Incidentaloma
Test	Cutoff	SE (%)	SP (%)	PPV (%)	NPV (%)	LR^pos	LR^neg
SE: sensitivity; SP: specificity; PPV: positive predictive value; NPV: negative predictive value; LR^pos: positive likelihood ratio; LR^neg: negative likelihood ratio. LR^pos cannot be calculated if SP = 100% and LR^neg cannot be calculated if SE = 100%.
1-mg DST	1.8 μg/dL	100	69.9	59.0	100	3.32	-
	5.0 μg/dL	83.3	96.4	90.0	93.0	23.1	0.173
LNSC	0.350 μg/dL	93.8	79.5	46.9	98.5	4.58	0.079
UFC	172 nmol/24h	85.4	100	100	93.3	-	0.146

Table 5. Performance of Screening Tests for Hypercortisolism in a Group of Patients With Adrenal Incidentaloma

Test

Cutoff

SE (%)

SP (%)

PPV (%)

NPV (%)

LR^pos

LR^neg

SE: sensitivity; SP: specificity; PPV: positive predictive value; NPV: negative predictive value; LR^pos: positive likelihood ratio; LR^neg: negative likelihood ratio. LR^pos cannot be calculated if SP = 100% and LR^neg cannot be calculated if SE = 100%.

1-mg DST

1.8 μg/dL

100

69.9

59.0

100

3.32

5.0 μg/dL

83.3

96.4

90.0

93.0

23.1

0.173

LNSC

0.350 μg/dL

93.8

79.5

46.9

98.5

4.58

0.079

UFC

172 nmol/24h

85.4

100

93.3

0.146