DHEAS and Differential Blood Counts as Indirect Signs of Glucocorticoid Excess in Adrenal Non-Producing Adenomas.
2021
The majority of incidentally discovered adrenal tumors are later characterized as
non-producing adrenocortical adenomas (NPA). We asked whether laboratory
abnormalities in parameters that reflect glucocorticoid action can be found in
patients with NPA despite their nature of being clinically unapparent. Since
glucocorticoids are potent immunosuppressants we studied blood counts and
differential blood counts along with corticotropin and dehydroepiandrostenedione
sulfate (DHEAS) blood concentrations, as well as cortisol values before and
after an overnight 1 mg dexamethasone suppression test. We compared the
results of normal individuals, of patients with adrenal adenomas and normal
hormone profiles and with subclinical autonomous glucocorticoid hypersecretion,
as well as overt cortisol excess. We found that almost all indices of the blood
counts were significantly different between the patients groups. In particular,
patients with adrenal non-producing adenomas already showed signs of
glucocorticoid excess, including relative lymphocytopenia, lowered DHEAS, and
ACTH concentrations than control individuals. We also found that the extent of
lymphocytopenia correlated with the concentrations of DHEAS and ACTH, and DHEAS
correlated well with ACTH. We conclude that the basal ACTH and DHEAS values
along with the differential blood counts give good information on the extent of
glucocorticoid excess and that silent adrenal adenomas seem to oversecrete
glucocorticoids at concentrations that already alter these parameters.
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