副肾皮质偶然发现瘤（AI）通常在断层成像中被发现。轻度自主皮质醇分泌是AI中最常见的功能障碍。为了描述良性肾上腺肿瘤的放射学特征和下丘脑-垂体-肾上腺（HPA）轴之间的关联。该研究纳入了494例诊断为良性单侧肾上腺皮质肿瘤的患者。当1mg地塞米松抑制试验（1-mg DST）后皮质醇范围为1.8-5ug/dl时，将诊断为轻度自主皮质醇分泌。当1-mg DST后皮质醇低于1.8ug/dL时，诊断为非功能性肾上腺皮质肿瘤（NFAT）。我们进行了逻辑回归和因果中介分析，寻找放射学特征与HPA轴之间的关联。494例患者中，纳入352例（71.3%）NFAT患者和142例（28.7%）MACS患者。MACS患者的肿瘤直径更大，对侧肾上腺腺体更薄，血浆ACTH和血清DHEAS较NFAT患者低。ACTH（OR 0.978，0.962-0.993）和肿瘤直径（OR 1.857，95%CI 1.357-2.540）是与血清DHEAS降低相关的独立因素（所有P＜0.05）。ACTH与对侧肾上腺腺体直径显著相关（OR 0.973，95%CI 0.957-0.988，P=0.001）。因果中介分析显示，在1-mg DST结果与DHEAS水平的关联中，ACTH的效应中介显著（Pmediation<0.001，比例=22.3%）。同时，我们发现ACTH在1-mg DST对对侧肾上腺腺体直径的影响中中介了39.7%的效应（Pmediation=0.012）。与NFAT相比，MACS患者的对侧肾上腺腺体更薄且HPA轴受到干扰。ACTH可能部分参与了自主皮质醇分泌与DHEAS以及对侧肾上腺腺体之间的中介作用。 版权所有 © 2023 Zhu、Wu、Su、Jiang、Zhou、Jiang、Zhang、Zhong和Wang。

Adrenal incidentaloma (AI) is commonly discovered on cross-sectional imaging. Mild autonomous cortisol secretion is the most common functional disorder detected in AI.To delineate the association between radiological characteristics of benign adrenocortical tumors and hypothalamus-pituitary-adrenal (HPA) axis.In the study, 494 patients diagnosed with benign unilateral adrenocortical tumors were included. Mild autonomous cortisol secretion (MACS) was diagnosed when cortisol after 1mg-dexamethasone suppression test (1-mg DST) was in the range of 1.8-5ug/dl. Non-functional adrenocortical tumor (NFAT) was diagnosed as cortisol following 1-mg DST less than 1.8ug/dL. We performed Logistics regression and causal mediation analyses, looking for associations between radiological characteristics and the HPA axis.Of 494 patients, 352 (71.3%) with NFAT and 142 (28.7%) with MACS were included. Patients with MACS had a higher tumor diameter, thinner contralateral adrenal gland, and lower plasma ACTH and serum DHEAS than those with NFAT. ACTH (OR 0.978, 0.962-0.993) and tumor diameter (OR 1.857, 95%CI, 1.357-2.540) were independent factors associated with decreased serum DHEAS (all P<0.05). ACTH was also associated with decreased contralateral adrenal diameter significantly (OR 0.973, 95%CI, 0.957-0.988, P=0.001). Causal mediation analysis showed ACTH mediated the effect significantly for the association between 1-mg DST results and DHEAS level (Pmediation<0.001, proportion=22.3%). Meanwhile, we found ACTH mediated 39.7% of the effects of 1-mg DST on contralateral adrenal diameter (Pmediation=0.012).Patients with MACS had thinner contralateral adrenal glands and disturbed HPA axes compared with NFAT. ACTH may partially be involved in mediating the mild autonomous cortisol secretion to DHEAS and the contralateral adrenal gland.Copyright © 2023 Zhu, Wu, Su, Jiang, Zhou, Jiang, Zhang, Zhong and Wang.