Table 3.
Characteristic | Postoperative glucocorticoid therapy duration, months | P | |
---|---|---|---|
A. Demographic Characteristics | |||
Sex | Male | 1.2 (0.6–4.0) | 0.002 |
Female | 5.7 (20.−12.3) | ||
BMI | for each 3 kg/m2 decrease | additional 0.9 (0.8–0.9) | 0.04 |
Age at the time of diagnosis | < 45 years old | 11.4 (5.1–14.0) | 0.001 |
≥ 45 years old | 2.3 (1.1–6.0) | ||
Duration of symptoms prior to diagnosis, years | ≤ 1 year | 2.8 (1.2–6.2) | 0.0007 |
> 1 year | 11.4 (2.2–16.9) | ||
Mode of Discovery | Incidental | 2.4 (1.2–6.0) | 0.004 |
Hormonal Excess | 9.2 (5.7–13.5) | ||
B. Tumor Characteristics | |||
Size of adrenal tumor, mm | ≥40 | 2.8 (0.9–6.0) | 0.02 |
<40 | 6.0 (1.8–13.5) | ||
C. Clinical Characteristics | |||
Weight gain prior to diagnosis | No | 2.2 (1.1–5.1) | 0.01 |
Yes | 5.9 (1.8–13.1) | ||
D. Physical Exam Findings | |||
Moon Facies | No | 2.2 (1.1–5.8) | <0.0001 |
Yes | 11.4 (5.7–16.0) | ||
Supraclavicular or dorsocervical fat pads | No | 2.3 (1.0–5.9) | 0.003 |
Yes | 8.5 (3.1–13.5) | ||
Skin changes | No | 2.6 (1.2–6.0) | 0.0006 |
Yes | 12.1 (6.3–16.0) | ||
Abdominal Obesity | No | 2.8 (1.2–6.0) | 0.007 |
Yes | 8.5 (2.2–13.5) | ||
Myopathy | No | 2.7 (1.2–6.2) | 0.002 |
Yes | 13.1 (6.0–16.0) | ||
Number of physical findings a | 0–1 | 2.2 (1.0–4.9) | <0.0001 |
2–3 | 5.7 (2.0–12.3) | ||
4–5 | 12.1 (6.3–16.9) | ||
E. Laboratory Results | |||
Urine free cortisol, μg/24h, nmol/24h, n=71 (Reference range: 3.5–45 μg/24h, 10–124 nmol/24h) |
≤45, ≤124 | 2.8 (1.1–6.0) | 0.0002 |
>45, >124 | 9.2 (2.2–16.0) | ||
Post 1-mg DST serum cortisol, μg/dL, nmol/L, n=69 (Reference range: <1.8 μg/dL, <50 nmol/L) |
≤10, ≤276 | 2.2 (1.1–5.7) | 0.0004 |
>10, >276 | 9.7 (2.3–13.5) | ||
ACTH, pg/mL, pmol/L, n=71 (Reference range: 10–60 pg/dL, 2.2–13.2 pmol/L, AM draw) |
>10, >2.2 | 1.3 (0.7–3.5) | 0.0006 |
≤10, ≤2.2 | 5.8 (2.0–13.1) | ||
Loss of circadian rhythm b, n=44 | Yes | 9.7 (2.6–14.0) | 0.002 |
No | 2.4 (1.8–5.5) | ||
Number of abnormal HPA axis tests c | 1–2 | 2.0 (0.9–4.0) | <0.0001 |
3–4 | 5.1 (1.6–13.1) | ||
5–6 | 12.3 (11.4–13.5) | ||
F. Postoperative Variables | |||
Postoperative glucocorticoid use for taper | Prednisone | 4.0 (1.4–12.3) | 0.59 |
Hydrocortisone | 4.0 (1.3–9.2) |
Data are summarized as median and interquartile ranges. All P-values <0.05 were considered significant.
Physical exam findings included: rounding and/or flushing of the face, abdominal obesity, skin changes (purple striae, thinning and/or easy bruising), subcutaneous supraclavicular and/or dorsocervical fat pads, and objective evidence of muscle weakness;
Loss of circadian rhythm defined as changes in normal variability of cortisol throughout the day, i.e. elevated PM cortisol;
Laboratory Tests included: 24hr urine free cortisol >45 μg/24h, post 1-mg DST cortisol >10 μg/dL, ACTH <10 pg/mL, midnight salivary cortisol >100 ng/dL, loss of circadian rhythm, and DHEA-S ≤50 μg/dL.
Abbreviations used: ACTH, corticotropin; BMI, body mass index; DHEA-S: Dehydroepiandrosterone sulfate; DST, dexamethasone suppression test; and, HPA, hypothalamic-pituitary-adrenal.