Epidemiology of Cushing’s Syndrome and Subclinical Disease

Ross, Nathan S.

doi:10.1016/s0889-8529(18)30082-3

Cited by 95 publications

(51 citation statements)

References 18 publications

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“…Some of these cases have been reported to be associated with subtle autonomous cortisol secretion that is insufficient to cause clinically overt Cushing's syndrome (9)(10)(11), and have been categorized as cases of preclinical (or subclinical) Cushing's syndrome (12)(13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

A Case of Aldosterone-Producing Adrenocortical Adenoma Associated with a Probable Post-Operative Adrenal Crisis: Histopathological Analyses of the Adrenal Gland

et al. 2003

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We describe a case of aldosterone-producing adrenocortical adenoma (APA) associated with a probable post-operative adrenal crisis possibly due to subtle autonomous cortisol secretion. The patient was a 46-year-old female who suffered from severe hypertension and hypokalemia. CT and MRI scans revealed a 2-cm diameter adrenal mass. The patient's plasma aldosterone level was increased, and her plasma renin activity was suppressed, both of which findings were consistent with APA. Cushingoid appearance was not ob-

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Section: Introductionmentioning

confidence: 99%

A Case of Aldosterone-Producing Adrenocortical Adenoma Associated with a Probable Post-Operative Adrenal Crisis: Histopathological Analyses of the Adrenal Gland

et al. 2003

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“…Although the term "preclinical" Cushing's syndrome has been proposed previously, the term "subclinical" Cushing's syndrome describes more accurately this condition, not implying any assumption on the further development of a clinically overt syndrome. Since the prevalence of overt Cushing's syndrome caused by adrenal adenoma in the general population is exceedingly lower than the prevalence of subclinical Cushing's syndrome in patients with clinically non-functioning adrenal adenoma, it is rather inappropriate to consider subclinical Cushing's syndrome as an early stage of development of overt hypercortisolism (1). Recently, the new definition of "subclinical autonomous glucocorticoid hypersecretion" has been proposed to identify this endocrine disorder (2) even if autonomous cortisol secretion may not be always associated with cortisol excess.…”

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confidence: 99%

Subclinical Cushing's syndrome

Terzolo

Bovio

Pia

et al. 2007

Arq Bras Endocrinol Metab

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Subclinical Cushing's syndrome (CS) is attracting increasing interest since the serendipitous discovery of an adrenal mass has become a rather frequent event owing to the routine use of sophisticated radiologic techniques. Cortical adenoma is the most frequent type of adrenal incidentaloma accounting for approximately 50% of cases in surgical series and even greater shares in medical series. Incidentally discovered adrenal adenomas may secrete cortisol in an autonomous manner that is not fully restrained by pituitary feedback, in 5 to 20% of cases depending on study protocols and diagnostic criteria. The criteria for qualifying subclinical cortisol excess are controversial and presently there is no consensus on a gold standard for the diagnosis of this condition. An increased frequency of hypertension, central obesity, impaired glucose tolerance, diabetes and hyperlipemia has been described in patients with subclinical CS; however, there is still no clear demonstration of the long-term complications of this condition whose management remains largely empirical. Either adrenalectomy or careful observation associated with treatment of the metabolic syndrome have been suggested as treatment options. RESUMO Síndrome de Cushing Subclínica.A síndrome de Cushing subclínica (SCS) tem atraído interesse cada vez maior desde que a descoberta casual de uma massa adrenal se tornou um evento freqüente devido ao emprego rotineiro de técnicas sofisticadas de imagem. O adenoma cortical é o tipo mais freqüente de incidentaloma adrenal, correspondendo a cerca de 50% dos casos em séries cirúrgicas e até mais do que isso em séries médicas. Adenomas adrenais descobertos incidentalmente podem secretar cortisol de maneira autônoma ou não controlada totalmente pelo feedback hipofisário, em 5 a 20% dos casos, dependendo do protocolo de estudo e dos critérios diagnósticos. Os critérios para qualificar um excesso subclínico de cortisol são controversos e atualmente não existe consenso a respeito de "padrão ouro" para o diagnóstico dessa condição. Em pacientes com SCS, tem sido descrita uma freqüência elevada de hipertensão, obesidade central, intolerância à glicose, diabetes e hiperlipemia; entretanto, ainda não existe uma evidente demonstração de complicações a longo prazo dessa condição, cujo manejo permanece amplamente empírico. Tanto a adrenalectomia como a observação cuidadosa, associada com o tratamento da síndrome metabólica, têm sido sugeridos como opções terapêuticas.

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“…Subclinical and preclinical conditions are generally distinguished by their long-term prognosis. Subclinical Cushing's syndrome would refer to a biochemical abnormality that never becomes clinically manifest, whereas preclinical Cushing's syndrome would refer to a stage in the development of the clinical syndrome [8]. Subclinical Cushing's disease was previously named as preclinical in Japan.…”

Section: Epidemiology Of Subclinical Cushing's Diseasementioning

confidence: 99%

“…Patients with SCAs exhibit none of the clinical features of Cushing's disease, have normal plasma cortisol levels, and do not have auton- The existence of subclinical or preclinical Cushing's diseases has raised intriguing questions [8]. The first case of preclinical Cushing's disease was reported by Sakai et al in Japan [19], and we have since reported another case of the disease [10].…”

Section: Epidemiology Of Subclinical Cushing's Diseasementioning

confidence: 99%

Pathophysiology and treatment of subclinical Cushing’s disease and pituitary silent corticotroph adenomas [Review]

et al. 2014

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Abstract. Pituitary adrenocorticotropic hormone (ACTH)-secreting tumor presents with a variety of clinical features. We outlined the features of ACTH release and characteristics of corticotroph adenoma cells. We especially focused on the corticotroph adenomas in patients with no clinical features of Cushing's disease. Subclinical Cushing's disease is defined by ACTH-induced mild hypercortisolism without typical features of Cushing's disease. Silent corticotroph adenomas (SCAs) are defined by normal cortisol secretion and ACTH-immunopositive staining without autonomous ACTH secretion. Clinicians who are not well-informed about the disease may sometimes confuse SCAs (because of their clinically silent nature) with "subclinical Cushing's disease". The recent criteria for diagnosing subclinical Cushing's disease in Japan are presented. Cortisol measurement was recently standardized in Japan, so plasma cortisol cutoff level should be reconsidered for the diagnosis. In patients with uncontrolled diabetes and hypertension despite appropriate treatment, subclinical Cushing's disease may be efficiently detected. Subclinical Cushing's disease may be associated with metabolic change. In subclinical Cushing's disease, mild hypercortisolism due to autonomous secretion of ACTH contributes to metabolic change and treatment of subclinical hypercortisolism can reverse this change.

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Epidemiology of Cushing’s Syndrome and Subclinical Disease

Cited by 95 publications

References 18 publications

A Case of Aldosterone-Producing Adrenocortical Adenoma Associated with a Probable Post-Operative Adrenal Crisis: Histopathological Analyses of the Adrenal Gland

A Case of Aldosterone-Producing Adrenocortical Adenoma Associated with a Probable Post-Operative Adrenal Crisis: Histopathological Analyses of the Adrenal Gland

Subclinical Cushing's syndrome

Pathophysiology and treatment of subclinical Cushing’s disease and pituitary silent corticotroph adenomas [Review]

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