Subclinical Cushing‚s Syndrome in Adrenal Incidentalomas: Diagnostic and Therapeutic Approaches to Prevention of Metabolic Disorders
Author: Kamenova, Teodora K., Elenkova, Atanaska P., Zacharieva, Sabina Z. Clinical Center of Endocrinology and Gerontology, Medical University, Sofia
Abstract: Subclinical Cushing’s syndrome (SCS) in patients with adrenal adenomas refers to the presence of chronic mild to moderate cortisol hypersecretion without specific signs and symptoms of classical Cushing`s syndrome which leads to serious diagnostic and therapeutic difficulties. Because of the lack of pathognomonic signs active screening for SCS should be carried out among patients with adrenal incidentalomas, metabolic syndrome, arterial hypertension, diabetes mellitus, dyslipidemia and osteoporosis. The effects of glucocorticoids on carbohydrate profile, blood pressure, lipid metabolism and bone are unfavorable and lead not only to deterioration in quality of life but also to increased morbidity and mortality. The diagnostic approach is complex and includes hormonal analysis, specific dynamic laboratory tests, determination of steroids using liquid chromatography/mass spectrometry (LC-MS) and medical imaging techniques (CT, MRI). The diagnosis of subclinical Cushing’s syndrome is based on the lack of suppression of cortisol after 1 mg Dexamethasone, suppressed ACTH and DHEA-S levelsand/or increased urine-free cortisol (UFC), elevated late night serum or salivary cortisol. Revealing molecular pathogenesis of subclinical hypercortisolism will allow optimization of the therapeutic approach. Treatment options are limited to adenomectomy or conservative therapy with blockers of adrenal steroidogenesis or glucocorticoid receptors.
Key words: Cushing‚s syndrome; subclinical hypercortisolism; adrenal incidentalomas