Hormonal Evaluation of Patients with an Incidentally Discovered Adrenal Mass

To the Editor: Ross and Aron (Nov. 15 issue) 1 recommend that the 1-mg dexamethasone suppression test for evaluating incidentally discovered adrenal masses be abandoned because Cushing's syndrome is rare. Although the authors acknowledge the existence of subclinical autonomous cortisol secretion, 2 3 4 5 they may underestimate the prevalence of this disorder. Recently, Gross and coworkers performed adrenal scintigraphy with [ 131 I]6β-iodomethyl-19-norcholesterol (NP-59) and bilateral simultaneous adrenal-vein catheterization in eight patients with adrenal masses discovered incidentally by CT. 6 In all patients, NP-59 was taken up on the side of the mass and adrenal-venous plasma cortisol concentrations were higher on the side of the mass. . . .