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

M. O. Van Aken, A. M. Pereira, S. W. Van Thiel, G. Van Den Berg, M. Frölich, J. D. Veldhuis, J. A. Romijn, F. Roelfsema

Research output: Contribution to journalArticle

20 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1570-1577
Number of pages8
JournalJournal of Clinical Endocrinology and Metabolism
Volume90
Issue number3
DOIs
StatePublished - Mar 1 2005

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

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    Van Aken, M. O., Pereira, A. M., Van Thiel, S. W., Van Den Berg, G., Frölich, M., Veldhuis, J. D., Romijn, J. A., & Roelfsema, F. (2005). Irregular and frequent cortisol secretory episodes with preserved diurnal rhythmicity in primary adrenal cushing's syndrome. Journal of Clinical Endocrinology and Metabolism, 90(3), 1570-1577. https://doi.org/10.1210/jc.2004-1281