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Endocrine Abstracts (2012) 29 S6.1

ICEECE2012 Symposia Subclinical adrenal diseases (3 abstracts)

Diagnosis and treatment of subclinical Cushing’s syndrome (SCS)

T. Yanase


School of Medicine, Fukuoka University, Fukuoka City, Japan.


SCS is defined as an adrenal tumor (usually adenoma) with autonomous cortisol secretion and no overt symptoms of Cushing’s syndrome. SCS has attracted much attention because it often is masked by lifestyle-related diseases such as diabetes mellitus (DM), metabolic syndrome (MS) and hypertension. Because of the broad variation in autonomous cortisol secretion among patients, diagnostic criteria for SCS have not been fully established. Furthermore, the cut-off values of the dexamethasone suppression test (DST) differ among current criteria. Diagnostic problems also arise because of differences in sensitivity among assay kits for the measurement of low serum cortisol levels. We have tried to establish diagnostic criteria for SCS based on the 1-mg DST cut-off value of serum cortisol of >1.8 μg/dl by analyzing 118 patients with adrenal incidentaloma. For the diagnosis of SCS, we finally selected two additional values (basal adrenocorticotropic hormone (ACTH) <10 pg/ml and serum cortisol ≥5 μg/dl at 23:00 h) from several parameters, because these values showed stronger associations with the results of the 1-mg DST than the other parameters. In some exceptional cases with basal ACTH ≥10 pg/ml, the poor response of ACTH to corticotropin-releasing hormone was equally important for accurate diagnosis. Patients who met these criteria had a significantly higher frequency of IGT/DM than did patients who did not meet these criteria. Improvements in metabolic parameters have been reported after removing the adrenal tumor in patients with SCS. However, it is sometimes a challenge to select operation for individuals with SCS, particularly for asymptomatic individuals showing no significant objective abnormalities. To overcome this problem, some reports have investigated the hormonal conditions of patients with SCS who showed improvements in metabolic profiles following the removal of the adrenal tumor.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

Volume 29

15th International & 14th European Congress of Endocrinology

European Society of Endocrinology 

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