Exp Clin Endocrinol Diabetes 2003; 111(7): 415-420
DOI: 10.1055/s-2003-44288
Article

J. A. Barth Verlag in Georg Thieme Verlag Stuttgart · New York

Adrenocortical Tumors: Prevalence of Impaired Glucose Tolerance and of “Paradoxical Rise” of Cortisol During an Oral Glucose Tolerance Test

H. Vierhapper 1 , G. Heinze 2 , A. Gessl 1 , M. Exner 3
  • 1Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, University of Vienna, Vienna, Austria
  • 2Institute for Medical Computer Sciences, University of Vienna, Vienna, Austria
  • 3Institute of Medical and Chemical Laboratory Diagnostics, University of Vienna, Vienna, Austria
Further Information

Publication History

Received: September 20, 2002 First decision: October 20, 2002

Accepted: February 24, 2003

Publication Date:
13 November 2003 (online)

Abstract

Glucose tolerance and the behaviour of cortisol during an oral glucose tolerance test (OGTT) was investigated in 126 patients with adrenal “incidentalomas” (age: > 45 years) and in 129 age-matched controls. Impaired glucose tolerance (IGT) was found to be more common (p < 0.02) among patients with adrenal incidentalomas. Subdividing these patients by their body weight it was found that 29 % (controls: 25 %) of those with normal body weight (BMI 20 - 25 kg/m2) had IGT/DM. In overweight (BMI 25 - 30 kg/m2) and obese patients (BMI 30 - 40 kg/m2) the share of IGT/DM was 32 % (controls: 19 %) and 66 % (controls 42 %), respectively. The prevalence of a “paradoxical” rise in serum cortisol concentrations during the OGTT was slightly higher (p < 0.05) among patients with adrenal incidentaloma than among controls. Patients as well as controls with this abnormal behaviour of cortisol were characterized by lower basal serum cortisol concentrations (p < 0.01) but no association was seen with either the presence of IGT or with post-dexamethasone concentrations of serum cortisol. Thus both in patients with and without adrenal incidentalomas abnormal glucose tolerance is an age- and weight-dependent phenomenon unrelated to the post-prandial behaviour of serum cortisol concentrations.

References

  • 1 Anderson W A, Kissane J M. Pathology. ed 7. St. Louis; Mosby 1977: 1671-1674
  • 2 Andres R. Aging and diabetes.  Med Clin North Amer. 1991;  55 835-846
  • 3 Andrews R C, Walker B R. Glucocorticoids and insulin resistance: old hormones, new targets.  Clin Sci. 1999;  96 513-523
  • 4 Baumgartner-Parzer S M, Pauschenwein S, Waldhäusl W, Pölzler K, Nowotny P, Vierhapper H. Increased prevalence of heterozygous 21-OH germ line mutations in patients with adrenal incidentalomas.  Clin Endocrinol. 2002;  56 811-816
  • 5 Beuschlein F, Borgemeister M, Schirra J, Goke B, Fassnacht M, Arlt W, Allolio B, Reincke M. Oral glucose tolerance testing but not intravenous glucose administration uncovers hyper-responsiveness of hypothalamo-pituitary-adrenal axis in patients with adrenal incidentalomas.  Clin Endocrinol. 2000;  52 617-623
  • 6 Biermann E L, Bagdale J D, Porte D. Obesity and diabetes: the odd couple.  Am J Clin Nutr. 1968;  21 1434-1437
  • 7 Björntorp P. Visceral obesity: “a civilisation syndrome”.  Obes Res. 1993;  1 206-222
  • 8 Dinnen S, Alzaid A, Miles J, Rizza R. Metabolic effects of the nocturnal rise in cortisol on carbohydrate metabolism in normal humans.  J Clin Invest. 1993;  92 2283-2290
  • 9 Everhart J E, Pettitt D J, Bennett P H, Knowler W C. Duration of obesity increases the incidence of NIDDM.  Diabetes. 1992;  42 235-240
  • 10 Fernandez-Real J M, Engel W R, Simo R, Salinas I, Webb S M. Study of glucose tolerance in consecutive patients harbouring incidental adrenal tumours.  Clin Endocrinol. 1998;  49 53-61
  • 11 Fruehwald-Schultes B, Kern W, Bong W, Wellhoener P, Kerner W, Born J, Fehm H L, Peters A. Supraphysiological hyperinsulinemia acutely increases hypothalamic-pituitary-adrenal secretory activity in humans.  J Clin Endocrinol Metab. 1999;  84 3041-3046
  • 12 Garrapa G G, Pantanetti P, Arnaldi G, Mantero F, Faloia E. Body composition and metabolic features in women with adrenal incidentaloma or Cushing's syndrome.  J Clin Endocrinol Metab. 2001;  86 5301-5306
  • 13 Harris M I, Hadden W C, Knowler W C, Bennet P H. Prevalence of diabetes and impaired glucose tolerance and plasma glucose levels in US population aged 20 - 74 yr.  Diabetes. 1987;  36 523-534
  • 14 Hedeland H, Ostberg G, Hokfeld B. On the prevalence of adrenocortical adenomas in an autopsy material in relation to hypertension and diabetes.  Acta Med Scand. 1968;  184 211-214
  • 15 Hosmer D W, Lemeshow S. Applied Logistic Regression. New York; Wiley 1989
  • 16 Jarrett R J, McCartney P, Keen H. The Bedford Survey: ten year mortality rates in newly diagnosed diabetics, borderline diabetics and normoglycaemic controls and risk indices for coronary heart disease in borderline diabetics.  Diabetologia. 1982;  22 79-84
  • 17 Korbonits M, Trainer P, Nelson M, Howse I, Kopelman P, Besser G, Grossman A, Svec F. Differential stimulation of cortisol and dehydroepiandrosterone levels by food in obese and normal subjects: relation to body fat distribution.  Clin Endocrinol (Oxf). 1996;  45 699-706
  • 18 Matthews D R, Hosker J P, Rudenski A S, Naylor B A, Treacher D F, Turner R C. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man.  Diabetologia. 1985;  28 412-419
  • 19 Mesiano S, Mellon S H, Jaffe R B. Mitogenic action, regulation, and localization of insulin-like growth factors in the human fetal adrenal gland.  J Clin Endocrinol Metab. 1993;  76 968-976
  • 20 Midorikawa S, Sanada H, Hashimoto S, Suzuki T, Watanabe T. The improvement of insulin resistance in patients with adrenal incidentaloma by surgical resection.  Clin Endocrinol. 2001;  54 797-804
  • 21 Reincke M, Nieke J, Krestin G P, Saeger W, Allolio B, Winkelmann W. Preclinical Cushing's Syndrome in adrenal “incidentalomas”: comparison with adrenal Cushing's syndrome.  J Clin Endocrinol Metab. 1992;  75 826-832
  • 22 Reincke M, Faßnacht M, Väth S, Mora P, Allolio B. Adrenal incidentalomas: a manifestation of the metabolic syndrome?.  Endocr Res. 1996;  22 757-761
  • 23 Ross N S, Aron D C. Hormonal evaluation of the patient with an incidentally discovered adrenal mass.  N Engl J Med. 1990;  323 1402-1405
  • 24 Ross N S. Epidemiology of Cushing's syndrome and subclinical disease.  Endocrinol Metab North Am. 1994;  23 539-546
  • 25 Rossi R, Tauchmanova L, Luciano A, Dimartino M, Battista C, Delviscovo L, Nuzzo V, Lombardi G. Subclinical Cushing's syndrome in patients with adrenal incidentaloma: Clinical and biochemical features.  J Clin Endocrinol Metab. 2000;  85 1440-1448
  • 26 Russi S, Blumenthal H T. Small adenomas of the adrenal cortex in hypertension and diabetes.  Arch Intern Med. 1945;  76 284-291
  • 27 Saad M F, Knowler W C, Pettitt D J, Nelson R G, Mott D M, Bennett P H. The natural history of impaired glucose tolerance in the Pima Indians.  New Engl J Med. 1988;  319 1500-1506
  • 28 Sluiter W J, Erkelens D W, Reitsma W D, Doorenbos H. Glucose tolerance and insulin release, a mathematical approach I. Assay of the beta-cell response after oral glucose loading.  Diabetes. 1976;  25 241-244
  • 29 Terzolo M, Pia A, Ali A, Osella G, Reimondo G, Bovio S, Daffara F, Procopio M, Paccotti P, Borretta G, Angeli A. Adrenal incidentaloma: A new cause of the metabolic syndrome?.  J Clin Endocrinol Metab. 2002;  87 998-1003
  • 30 Vierhapper H. Adrenocortical tumors: clinical symptoms and biochemical diagnosis.  Europ J Radiol. 2002;  41 88-94
  • 31 Waldhäusl W, Herkner K, Nowotny P, Bratusch-Marrain P. Combined 17α- and 18-hydroxylase deficiency associated with complete male pseudohermaphroditism and hypoaldosteronism.  J Clin Endocrinol Metab. 1978;  46 236-246
  • 32 Waldhäusl W, Kleinberger G, Korn A, Dudczak R, Bratusch-Marrain P, Nowotny P. Severe hyperglycemia: effects of rehydration on endocrine derangements and blood glucose concentration.  Diabetes. 1979;  28 577-584
  • 33 World Health Organization Study Group .Diabetes Mellitus. WHO Technical Report Series 727. Geneva, Switzerland; World Health Organization 1985
  • 34 Young W F. Management approaches to adrenal incidentalomas. A view from Rochester, Minnesota.  Endocr Metab Clin North Am. 2000;  29 159-185

M. D. H. Vierhapper

Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III
University of Vienna

Währinger Gürtel 18 - 20

1090 Wien

Austria

Phone: +43(1)404004348

Fax: + 43 (1) 4 04 00 62 10

Email: h.vierhapper@akh-wien.ac.at

    >