Michio Otsuki
   Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine
   Position   Professor and Division head
Article types Original article
Language English
Peer review Peer reviewed
Title Clinical significance of screening for subclinical Cushing's disease in patients with pituitary tumors
Journal Formal name：Endocrine Journal
Abbreviation：Endocr J
ISSN code：09188959
Domestic / ForeginDomestic
Volume, Issue, Page 63(1),pp.47-52
Author and coauthor Tamada, D. Kitamura, T. Otsuki, M. Oshino, S. Saitoh, Y. Shimomura, I.
Authorship Corresponding author
Publication date 2016
Summary 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
Document No. 26536898