オオツキ　ミチオ   Michio Otsuki   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	総説
言語種別	英語
査読の有無	査読あり
表題	New diagnostic criteria of adrenal subclinical Cushing's syndrome: opinion from the Japan Endocrine Society
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	65(4),pp.383-393
著者・共著者	Yanase, T. Oki, Y. Katabami, T. Otsuki, M. Kageyama, K. Tanaka, T. Kawate, H. Tanabe, M. Doi, M. Akehi, Y. Ichijo, T.
発行年月	2018
概要	New diagnostic criteria and the treatment policy for adrenal subclinical Cushing's syndrome (SCS) are proposed on behalf of the Japan Endocrine Society. The Japanese version has been published, and the essential contents are presented in this English-language version. The current diagnostic criteria for SCS have elicited two main problems: (i) the relatively low reliability of a low range of serum cortisol essential for the diagnosis by an overnight 1-mg dexamethasone suppression test (DST); (ii) different cutoff values for serum cortisol after a 1-mg DST compared with those of other countries. Thus, new criteria are needed. In the new criteria, three hierarchical cortisol cutoff values, 5.0, 3.0 and 1.8 mug/dL, after a 1-mg DST are presented. Serum cortisol>/=5 mug/dL after a 1-mg DST alone is considered sufficient to judge autonomous cortisol secretion for the diagnosis of SCS, and the current criterion based on serum cortisol>/=3 mug/dL after a 1-mg DST can continue to be used. Clinical evidence suggests that serum cortisol>/=1.8-2.9 mug/dL after a 1-mg DST is not always normal, so cases who meet the cutoff value as well as a basal adrenocorticotropic hormone (ACTH) level<10 pg/mL (or poor ACTH response to corticotropin-releasing hormone (CRH)) and nocturnal serum cortisol>/=5 mug/dL are proposed to have SCS. We suggest surgery if cases show serum cortisol>/=5 mug/dL after a 1-mg DST (or are disheartened by treatment-resistant problems) or suspicious cases of adrenal cancer according to tumor imaging.
DOI	10.1507/endocrj.EJ17-0456
文献番号	29576599