Irregular and frequent cortisol secretory episodes with preserved diurnal rhythmicity in primary adrenal Cushing's syndrome

The Journal of Clinical Endocrinology and Metabolism
M O van AkenFerdinand Roelfsema

Abstract

To evaluate the pathophysiology of altered cortisol secretion in patients with primary adrenal hypercortisolism, cortisol secretion was investigated in 12 patients, seven with a unilateral adenoma and five with ACTH-independent macronodular adrenal hyperplasia compared with age- and gender-matched controls and with patients with pituitary-dependent hypercortisolism. Pulsatile secretion was increased 2-fold (P = 0.04), attributable to increased event frequency (P = 0.002). All patients showed a significant diurnal rhythm with a delay in phase shift of 3 h (P = 0.01). Approximate entropy ratio, a feedback-sensitive measure, was increased compared with controls (P = 0.00003) but similar to that of pituitary-dependent hypercortisolism (P = 0.77), denoting loss of autoregulation. Cortisol burst-mass tended to be smaller in patients with ACTH-independent macronodular adrenal hyperplasia than in unilateral adenoma (P = 0.06). In conclusion, increased cortisol secretion in patients with primary adrenal Cushing's syndrome is caused by amplified pulsatile secretion via event frequency modulation. We speculate that partial preservation of secretory regularity and diurnal rhythmicity point to incomplete autonomy of these tumors.

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Citations

Dec 4, 2008·Pituitary·Ferdinand RoelfsemaJohannes A Romijn
Nov 29, 2013·The New England Journal of Medicine·Estelle LouisetHervé Lefebvre
Oct 23, 2008·Endocrine Reviews·Johannes D VeldhuisSteven M Pincus
Mar 1, 2012·PloS One·Ferdinand RoelfsemaJohannes D Veldhuis
Oct 6, 2011·Physiology & Behavior·R A SarabdjitsinghE R de Kloet
Jan 10, 2018·Clinical Endocrinology·Laura I StirratRebecca M Reynolds
Oct 22, 2019·Experimental and Clinical Endocrinology & Diabetes : Official Journal, German Society of Endocrinology [and] German Diabetes Association·Mohammad Sheikh-AhmadLeonard Saiegh
Dec 18, 2020·Frontiers in Physiology·Eder ZavalaKrasimira Tsaneva-Atanasova

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