Table 1.
Hormonal and biochemical workup in patients with suspected ACC.
| Category of hormonal excess | Recommended test(s) |
|---|---|
| Glucocorticoid excess | 1 mg dexamethasone suppression test |
| Basal ACTH (plasma) a | |
| Sex steroids and steroid precursors b | DHEA-S |
| 17-hydroxyprogesterone | |
| Androstenedione | |
| Testosterone (only in women) | |
| 17-beta-estradiol (only in men and postmenopausal women) | |
| 11-deoxycortisol | |
| Mineralocorticoid excess | Serum potassium |
| Aldosterone/renin ratio (only in patients with arterial hypertension and/or hypokalemia) | |
| Catecholamine excess (for exclusion of pheochromocytoma) | Free plasma-metanephrines or 24-h urinary fractionated metanephrines |
Table adapted from Fassnacht et al. 5
a
Can be omitted if hypercortisolism is excluded.
b
The most suitable set of precursors and sex hormones has not yet been established and local testing availability may dictate what tests are available.
ACTH, adrenocorticotropic hormone; DHEA-S, dehydroepiandrosterone sulfate.