Med Bull Sisli Etfal Hosp. 2024; 58(2): 204-209 | DOI: 10.14744/SEMB.2024.12258

Choroidal Thickness in Mild Autonomous Cortisol Secretion

Sezin Dogan Cakir¹, Akin Cakir², Feyza Yener Ozturk³, Seda Erem Basmaz⁴, Adnan Batman⁵, Emre Sedar Saygili⁶, Rumeysa Selvinaz Erol³, Esra Cil Sen³, Muhammed Masum Canat³, Yuksel Altuntas^3
1Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Health Sciences Türkiye, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Türkiye
²Department of Ophthalmology, University of Health Sciences Türkiye, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Türkiye
³Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
⁴Division of Endocrinology and Metabolism, Department of Internal Medicine, Derince Training and Research Hospital, Kocaeli, Türkiye
⁵Division of Endocrinology and Metabolism, Department of Internal Medicine, Koc University Faculty of Medicine, Istanbul, Türkiye
⁶Division of Endocrinology and Metabolism, Department of Internal Medicine, Canakkale Onsekiz Mart University Faculty of Medicine, Canakkale, Türkiye

Objectives: To evaluate the patients with mild autonomous cortisol secretion (MACS) by means of choroidal thickness (CT) and also investigate whether CT may be a diagnostic tool in the management of MACS or not.
Methods: Twenty-seven patients with MACS and 25 age-sex-matched healthy controls were enrolled in this cross-sectional comparative study. All the participants underwent CT measurement by using Spectralis optical coherence tomography (Heidelberg Engineering, Heidelberg, Germany) with enhanced deep imaging mode at the subfoveal, 500-1000-1500 μm nasal and 500-1000- 1500 μm temporal to the foveola.
Results: The groups were similar in terms of spherical equivalence, age and axial lengths. The mean CT was significantly thicker in patients with MACS than controls in all measurement quadrants (p<0.001). There was no significant correlation between CT, size of the adenoma, basal cortisol, 1mg dexamethasone suppression test, salivary cortisol, 24-hour total urine-free cortisol, ACTH and DHEAS levels. However, 2 mg dexamethasone suppression test results were found to be significantly correlated with CT in temporal 500-1000 and 1500 μm quadrants (r=0.436, p=0.023, r=0.443, p=0.021 and r=0.488, p=0.010, respectively). Five (18.5%) eyes had pachychoroid pigment epitheliopathy in the MACS group.
Conclusion: CT increases in patients with MACS and those tend to have pachychoroid pigment epitheliopathy more frequent than healthy individuals. A thicker choroid in the patients with MACS may be a novel biomarker both as a diagnostic tool for the degree of hypercortisolemia and cortisol-related comorbidity.

Keywords: Choroidal thickness, mild autonomous cortisol secretion, optical coherence tomography, possible autonomous cortisol secretion

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Ilýmlý Otonom Kortizol Sekresyonunda Koroid Kalýnlýðý

Sezin Dogan Cakir¹, Akin Cakir², Feyza Yener Ozturk³, Seda Erem Basmaz⁴, Adnan Batman⁵, Emre Sedar Saygili⁶, Rumeysa Selvinaz Erol³, Esra Cil Sen³, Muhammed Masum Canat³, Yuksel Altuntas^3
1Türkiye Saðlýk Bilimleri Üniversitesi, Prof. Dr. Cemil Taþçýoðlu Þehir Hastanesi, Ýç Hastalýklarý-Endokrinoloji ve Metabolizma Kliniði, Ýstanbul
²Türkiye Saðlýk Bilimleri Üniversitesi, Prof. Dr. Cemil Taþçýoðlu Þehir Hastanesi, Göz Hastalýklarý Kliniði, Ýstanbul
³Türkiye Saðlýk Bilimleri Üniversitesi, Þiþli Hamidiye Etfal Eðitim ve Araþtýrma Hastanesi, Ýç Hastalýklarý-Endokrinoloji ve Metabolizma Kliniði, Ýstanbul
⁴Derince Eðitim ve Araþtýrma Hastanesi, Ýç Hastalýklarý-Endokrinoloji ve Metabolizma Kliniði, Kocaeli
⁵Koç Üniversitesi Týp Fakültesi, Ýç Hastalýklarý Anabilim Dalý, Endokrinoloji ve Metabolizma Bilim Dalý, Ýstanbul
⁶Çanakkale Onsekiz Mart Üniversitesi Týp Fakültesi, Ýç Hastalýklarý Anabilim Dalý, Endokrinoloji ve Metabolizma Bilim Dalý, Çanakkale

Amaç: Ilýmlý Otonom Kortizol Sekresyonu (IOKS) olan hastalarý koroid kalýnlýðý (KK) açýsýndan deðerlendirmek ve KK'nýn IOKS yönetiminde bir taný aracý olup olamayacaðýný araþtýrmak.
Yöntem: Bu kesitsel karþýlaþtýrmalý çalýþmaya IOKS saptanan 27 hasta ile yaþ ve cinsiyet açýsýndan uyumlu 25 saðlýklý kontrol grubu olarak dahil edildi. Tüm katýlýmcýlara Spektralis Optik Koherens Tomografi (Heidelberg Engineering, Heidelberg, Almanya) cihazý kullanýlarak subfoveal, 500-1000-1500 µm nazal ve 500-1000-1500 µm temporal foveolada geliþtirilmiþ derin görüntüleme modu kullanýlarak KK ölçümü yapýldý.
Bulgular: Gruplar sferik ekivalan, yaþ ve aksiyal uzunluklar açýsýndan benzerdi. Ortalama KK, tüm ölçüm kadranlarýnda IOKS hastalarýnda kontrollere göre anlamlý derecede daha kalýndý (p<0.001). Koroid kalýnlýðý ile adenom büyüklüðü, 1mg deksametazon supresyon testi, tükrük kortizolü, 24 saat idrar serbest kortizolü, bazal kortizol, ACTH ve DHEAS düzeyleri arasýnda anlamlý bir iliþki saptanmadý. Ancak 2 mg deksametazon supresyon testi sonuçlarýnýn temporal 500-1000 ve 1500 µm kadranlarda KK ile anlamlý düzeyde iliþkili olduðu görüldü (r=0.436, p=0.023; r=0.443, p=0.021 ve r=0.488, p=0.010; sýrasýyla). IOKS grunuda 5 (%18.5) hastada pakikoroid pigment epitelyopati izlendi.
Sonuç: Ilýmlý Otonom Kortizol Sekresyonu olan hastalarda, KK ve pakikoroid pigment epitelyopati sýklýðý artmaktadýr. Ilýmlý Otonom Kortizol Sekresyonu olan hastalarda daha kalýn koroid, hem hiperkortizoleminin derecesi hem de hiperkortizolemi iliþkili komorbidite varlýðý için tanýsal bir araç olarak yeni bir biyobelirteç olabilir. (SETB-2023-11-206)

Anahtar Kelimeler: Koroid kalýnlýðý, ýlýmlý otonom kortizol sekresyonu, optik koherens tomografi, olasý otonom kortizol sekresyonu

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