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Original Article
- Clinical Study
- The Recovery of Hypothalamic-Pituitary-Adrenal Axis Is Rapid in Subclinical Cushing Syndrome
- Hee Kyung Kim, Jee Hee Yoon, Yun Ah Jeong, Ho-Cheol Kang
- Endocrinol Metab. 2016;31(4):592-597. Published online December 20, 2016
- DOI: https://doi.org/10.3803/EnM.2016.31.4.592
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- 45 Download
- 8 Web of Science
- 8 Crossref
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Abstract
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PubReader Background In subclinical Cushing syndrome (SC), it is assumed that glucocorticoid production is insufficient to cause a clinically recognizable syndrome. Differences in hormonal levels or recovery time of the hypothalamic-pituitary-adrenocortical (HPA) axis after adrenalectomy between patients with overt Cushing syndrome (OC) and SC remain unknown.
Methods Thirty-six patients (10 with OC and 26 with SC) with adrenal Cushing syndrome who underwent adrenalectomy from 2004 to 2014 were reviewed retrospectively. Patients were treated with glucocorticoid after adrenalectomy and were reevaluated every 1 to 6 months using a rapid adrenocorticotropic hormone (ACTH) stimulation test.
Results Levels of basal 24-hour urine free cortisol (UFC), serum cortisol after an overnight dexamethasone suppression test (DST), and serum cortisol and 24-hour UFC after low-dose DST and high-dose DST were all significantly lower in patients with SC compared with OC. Basal ACTH levels showed significantly higher in patients with SC compared with OC. The probability of recovering adrenal function during follow-up differed significantly between patients with OC and SC (
P =0.001), with significant correlations with the degree of preoperative cortisol excess. Patients with OC required a longer duration of glucocorticoid replacement to recover a normal ACTH stimulation test compared with patients with SC (median 17.0 months vs. 4.0 months,P <0.001).Conclusion The HPA axis recovery time after adrenalectomy in patients with SC is rapid and is dependent on the degree of cortisol excess. More precise definition of SC is necessary to achieve a better management of patients and to avoid the risk of under- or over-treatment of SC patients.
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Citations
Citations to this article as recorded by
- Hypothalamic–pituitary–adrenal axis recovery after treatment of Cushing's syndrome
Annemarie Balasko, Karin Zibar Tomsic, Darko Kastelan, Tina Dusek
Journal of Neuroendocrinology.2022;[Epub] CrossRef - Early assessment of postoperative adrenal function is necessary after adrenalectomy for mild autonomous cortisol secretion
Trenton Foster, Irina Bancos, Travis McKenzie, Benzon Dy, Geoffrey Thompson, Melanie Lyden
Surgery.2021; 169(1): 150. CrossRef - Is Prophylactic Steroid Treatment Mandatory for Subclinical Cushing Syndrome After Unilateral Laparoscopic Adrenalectomy?
Dong Wang, Han-zhong Li, Yu-shi Zhang, Liang Wang, Zhi-gang Ji
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2019; 29(1): 31. CrossRef - When to Intervene for Subclinical Cushing's Syndrome
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Surgical Clinics of North America.2019; 99(4): 747. CrossRef - Serum Cortisol Levels via Radioimmunoassay vs Liquid Chromatography Mass Spectrophotometry in Healthy Control Subjects and Patients With Adrenal Incidentalomas
Martha K P Huayllas, Brian C Netzel, Ravinder J Singh, Claudio E Kater
Laboratory Medicine.2018;[Epub] CrossRef - Contralateral adrenal width predicts the duration of prolonged post‐surgical steroid replacement for subclinical Cushing syndrome
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International Journal of Urology.2018; 25(6): 583. CrossRef - Predictability of hypoadrenalism occurrence and duration after adrenalectomy for ACTH-independent hypercortisolism
V. Morelli, L. Minelli, C. Eller-Vainicher, S. Palmieri, E. Cairoli, A. Spada, M. Arosio, I. Chiodini
Journal of Endocrinological Investigation.2018; 41(4): 485. CrossRef - Articles inEndocrinology and Metabolismin 2016
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Endocrinology and Metabolism.2017; 32(1): 62. CrossRef
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