オオツキ　ミチオ   Ootsuki Michio   大月　道夫    所属   医学部 医学科（東京女子医科大学病院）    職種   教授・基幹分野長
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	Clinical significance of screening for subclinical Cushing's disease in patients with pituitary tumors
掲載誌名	正式名：Endocrine Journal 略　 称：Endocr J ISSNコード：09188959
掲載区分	国内
巻・号・頁	63(1),pp.47-52
著者・共著者	Tamada, D. Kitamura, T. Otsuki, M. Oshino, S. Saitoh, Y. Shimomura, I.
担当区分	責任著者
発行年月	2016
概要	Cushing's syndrome (CS) is a clinical state caused by chronic excess of glucocorticoid, and results in hypertension, impaired glucose tolerance, and dyslipidemia. Recently, a mild state of pituitary CS without typical Cushingoid appearance (subclinical Cushing's disease; SCD) has been identified. However, the true prevalence of SCD and its effect on metabolic disorders remain obscure. The aim of this prospective study was to determine the prevalence of SCD according to the guideline proposed by the working group of the Japanese Ministry of Health, Welfare and Labor, and to assess the outcome of surgery on metabolic disorders. The prevalence of SCD was investigated in 105 consecutive patients diagnosed with pituitary adenomas by MRI. ACTH-dependent hypercortisolism was diagnosed based on the results of the 0.5 mg dexamethasone suppression test (serum cortisol>3.0 mug/dL) plus one positive finding of the following two tests: midnight serum cortisol level>5.0 mug/dL or ACTH increase>50% after 1-deamino-5-D-arginine vasopressin (DDAVP) challenge. The final diagnosis of SCD was established by positive staining for ACTH in surgically-excised pituitary adenoma. Three patients (4.8%) were diagnosed with SCD among 62 patients with pituitary adenoma. Transsphenoidal adenomectomy partially resulted in improvement of blood pressure and glucose metabolism in SCD patients. Our results emphasize the importance of SCD screening in patients with pituitary tumors, especially in those patients with metabolic disorders.
DOI	10.1507/endocrj.EJ15-0446
文献番号	26536898