The Role of Cortisol Secretion in Pheochromocytomas and Paragangliomas: Clinical and Perioperative Implications
Authors' conclusion
One-quarter of patients with PPGLs exhibit autonomous cortisol secretion, associated with larger tumors, higher diabetes prevalence, and increased perioperative risks. Routine DST screening may improve preoperative management and offer insights into the impact of cortisol on PPGLs outcomes.
Study context
- Population
- Patients with pheochromocytomas and paragangliomas (PPGLs) who underwent adrenalectomy or extra-adrenal surgery for paragangliomas
- Participants
- 106 patients
- Exposure
- Nonsuppressive vs suppressive cortisol after 1-mg dexamethasone suppression test (DST)
- Outcome
- Prevalence of autonomous cortisol secretion (nonsuppressive cortisol post-DST)
Methodological details2 tertiary endocrinology centers
- 2 tertiary endocrinology centers
Main finding
As reported in the abstract
Nonsuppressive cortisol post-DST
Prevalence of nonsuppressive cortisol concentrations post-DST
24.5%
Observational data: associations, not effects.
Further findings
Age
P < 0.001
Female
P = 0.001
Diabetes before adrenalectomy/surgery
P < 0.05
Diabetes after adrenalectomy/surgery
P < 0.05
Tumor size
P < 0.05
Metanephrines, DHEAS, CVD
- Nonsuppressive: higher urinary and plasma metanephrines, lower DHEAS, more CVD
Safety
| Outcome | P value |
|---|---|
| Perioperative complications (blood loss, conversion to open surgery, prolonged hospital stay)More frequent with Nonsuppressive | P < 0.05 |
Original publication
The Role of Cortisol Secretion in Pheochromocytomas and Paragangliomas: Clinical and Perioperative Implications. J Clin Endocrinol Metab. Published 19 June 2025. doi:10.
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