Comparative analysis of plasma 17-hydroxyprogesterone and cortisol responses to ACTH in patients with various adrenal tumors before and after unilateral adrenalectomy

Patients with non-hyperfunctioning adrenal adenomas often have an increased plasma 17-hydroxyprogesterone response to ACTH stimulation. The effects of adrenal surgery on this abnormality have rarely been investigated. One hun dred and sixty-one patients with unilateral adrenal tumors (non-hyperfuncti oning adenomas, 78; cortisol-producing adenomas, 8; aldosterone-producing a denomas, 37; adrenal cysts, 12; pheochromocytomas, 26) were studied. Patien ts before and after adrenal surgery as well as 60 healthy subjects underwen t an ACTH stimulation test using 2 mg synthetic ACTH(1-24) (Cortrosyn Depot , Organon). Basal and ACTH-stimulated plasma 17-hydroxyprogesterone and cor tisol concentrations are reported. Before adrenal surgery, the basal plasma 17-hydroxyprogesterone concentrations were normal in patients with all typ es of tumors. However, the ACTH-stimulated plasma 17-hydroxyprogesterone le vels were abnormally increased in 53% and 31% of patients with non-hyperfun ctioning adenomas and aldosterone-producing adenomas, respectively. In addi tion, a few patients with adrenal cysts and pheochromocytomas also showed a n increased ACTH-stimulated 17-hydroxyprogesterone response. After unilater al adrenalectomy, this hormonal abnormality disappeared in most, although n ot all patients with adrenal tumors. In patients with non-hyperfunctioning adrenal tumors, ACTH-stimulated plasma 17-hydroxyprogesterone and cortisol concentrations significantly correlated with the size of the tumors. These results firmly indicate that the tumoral mass itself may be responsible for the increased plasma 17-hydroxyprogesterone and cortisol responses after A CTH stimulation in patients with non-hyperfunctioning and hyperfunctioning adrenal adenomas. (C) 2000. Editrice Kurtis.