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Dexamethasone Suppression Testing in a Contemporary Cohort with Adrenal Incidentalomas in Two U.S. Integrated Healthcare Systems

Authors :
Mackenzie Crawford
Bennett McDonald
Wansu Chen
Hina Chowdhry
Richard Contreras
Iris Anne C. Reyes
Eleena Dhakal
Tish Villanueva
Joshua I. Barzilay
Candace F. Vaughn
Frank S. Czerwiec
David A. Katz
Annette L. Adams
Jennifer C. Gander
Source :
Biomedicines, Vol 11, Iss 12, p 3167 (2023)
Publication Year :
2023
Publisher :
MDPI AG, 2023.

Abstract

Autonomous cortisol secretion (ACS) from an adrenal adenoma can increase the risk for comorbidities and mortality. The dexamethasone suppression test (DST) is the standard method to diagnose ACS. A multi-site, retrospective cohort of adults with diagnosed adrenal tumors was used to understand patient characteristics associated with DST completion and ACS. Time to DST completion was defined using the lab value and result date; follow-up time was from the adrenal adenoma diagnosis to the time of completion or censoring. ACS was defined by a DST > 1.8 µg/dL (50 nmol/L). The Cox proportional hazards regression model assessed associations between DST completion and patient characteristics. In patients completing a DST, a logistic regression model evaluated relationships between elevated ACS and covariates. We included 24,259 adults, with a mean age of 63.1 years, 48.1% obese, and 28.7% with a Charlson comorbidity index ≥ 4. Approximately 7% (n = 1768) completed a DST with a completion rate of 2.36 (95% CI 2.35, 2.37) per 100 person-years. Fully adjusted models reported that male sex and an increased Charlson comorbidity index were associated with a lower likelihood of DST completion. Current or former smoking status and an increased Charlson comorbidity index had higher odds of a DST > 1.8 μg/dL. In conclusion, clinical policies are needed to improve DST completion and the management of adrenal adenomas.

Details

Language :
English
ISSN :
22279059
Volume :
11
Issue :
12
Database :
Directory of Open Access Journals
Journal :
Biomedicines
Publication Type :
Academic Journal
Accession number :
edsdoj.1fa01d8f277741f4861884381246afd9
Document Type :
article
Full Text :
https://doi.org/10.3390/biomedicines11123167