Michio Otsuki
   Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine
   Position   Professor and Division head
Article types Review article
Language English
Peer review Peer reviewed
Title New diagnostic criteria of adrenal subclinical Cushing's syndrome: opinion from the Japan Endocrine Society
Journal Formal name：Endocrine journal
Abbreviation：Endocr J
ISSN code：09188959
Domestic / ForeginDomestic
Volume, Issue, Page 65(4),pp.383-393
Author and coauthor Yanase, T. Oki, Y. Katabami, T. Otsuki, M. Kageyama, K. Tanaka, T. Kawate, H. Tanabe, M. Doi, M. Akehi, Y. Ichijo, T.
Publication date 2018
Summary 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
Document No. 29576599