TY - JOUR
T1 - "Subclinical Cushing's syndrome" is not subclinical
T2 - improvement after adrenalectomy in 9 patients
AU - Mitchell, Ian C.
AU - Auchus, Richard J.
AU - Juneja, Kavita
AU - Chang, Alice Y.
AU - Holt, Shelby A.
AU - Snyder, William H.
AU - Nwariaku, Fiemu E.
PY - 2007/12
Y1 - 2007/12
N2 - Background: A subgroup of patients with adrenal cortisol hypersecretion fails to meet the biochemical criteria for Cushing's syndrome. Appropriate therapy for this entity, subclinical Cushing's syndrome (subclinical CS), is unclear. We examined outcomes for patients who underwent unilateral adrenalectomy for subclinical CS. Methods: Between 2003 and 2006, all patients who underwent adrenalectomy for cortisol hypersecretion caused by an adrenal mass were examined. We analyzed biochemical, metabolic, and clinical outcomes. Results: Overall, 24 patients underwent adrenalectomy for adrenal cortisol hypersecretion, of which 9 were found to have subclinical CS. Median serum cortisol was 2.0 μg/dL (range, 1.1-6.1) after 1-mg overnight dexamethasone suppression testing. Suspicious clinical findings on preoperative examination included skin bruising, unexplained weight gain, proximal muscle weakness, abnormal fat pads, skin thinning, fatigue, and facial plethora. During a median follow-up period of 5 months (range, 1-30 months), all 8 patients with easy bruising noted resolution postoperatively. Fatigue improved in 4 of 5 patients, muscle weakness in 6 of 8 patients, and weight in 7 of 9 patients, with a median body mass index change of -2.0 kg/m2 (range, -7.1 to +0.5 kg/m2). Conclusion: Adrenalectomy improves clinical and metabolic parameters for many patients with subclinical CS.
AB - Background: A subgroup of patients with adrenal cortisol hypersecretion fails to meet the biochemical criteria for Cushing's syndrome. Appropriate therapy for this entity, subclinical Cushing's syndrome (subclinical CS), is unclear. We examined outcomes for patients who underwent unilateral adrenalectomy for subclinical CS. Methods: Between 2003 and 2006, all patients who underwent adrenalectomy for cortisol hypersecretion caused by an adrenal mass were examined. We analyzed biochemical, metabolic, and clinical outcomes. Results: Overall, 24 patients underwent adrenalectomy for adrenal cortisol hypersecretion, of which 9 were found to have subclinical CS. Median serum cortisol was 2.0 μg/dL (range, 1.1-6.1) after 1-mg overnight dexamethasone suppression testing. Suspicious clinical findings on preoperative examination included skin bruising, unexplained weight gain, proximal muscle weakness, abnormal fat pads, skin thinning, fatigue, and facial plethora. During a median follow-up period of 5 months (range, 1-30 months), all 8 patients with easy bruising noted resolution postoperatively. Fatigue improved in 4 of 5 patients, muscle weakness in 6 of 8 patients, and weight in 7 of 9 patients, with a median body mass index change of -2.0 kg/m2 (range, -7.1 to +0.5 kg/m2). Conclusion: Adrenalectomy improves clinical and metabolic parameters for many patients with subclinical CS.
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U2 - 10.1016/j.surg.2007.10.001
DO - 10.1016/j.surg.2007.10.001
M3 - Article
C2 - 18063074
AN - SCOPUS:36549012640
SN - 0039-6060
VL - 142
SP - 900-905.e1
JO - Surgery
JF - Surgery
IS - 6
ER -