"Subclinical Cushing's syndrome" is not subclinical: improvement after adrenalectomy in 9 patients.
BACKGROUND
A subgroup of patients with adrenal cortisol hypersecretion fails to meet the biochemical criteria for Cushing's syndrome. Appropriate therapy for this entity, subclinical Cushing's syndrome (subclinical CS), is unclear. We examined outcomes for patients who underwent unilateral adrenalectomy for subclinical CS.


METHODS
Between 2003 and 2006, all patients who underwent adrenalectomy for cortisol hypersecretion caused by an adrenal mass were examined. We analyzed biochemical, metabolic, and clinical outcomes.


RESULTS
Overall, 24 patients underwent adrenalectomy for adrenal cortisol hypersecretion, of which 9 were found to have subclinical CS. Median serum cortisol was 2.0 microg/dL (range, 1.1-6.1) after 1-mg overnight dexamethasone suppression testing. Suspicious clinical findings on preoperative examination included skin bruising, unexplained weight gain, proximal muscle weakness, abnormal fat pads, skin thinning, fatigue, and facial plethora. During a median follow-up period of 5 months (range, 1-30 months), all 8 patients with easy bruising noted resolution postoperatively. Fatigue improved in 4 of 5 patients, muscle weakness in 6 of 8 patients, and weight in 7 of 9 patients, with a median body mass index change of -2.0 kg/m(2) (range, -7.1 to +0.5 kg/m(2)).


CONCLUSIONS
Adrenalectomy improves clinical and metabolic parameters for many patients with subclinical CS.
Division of Gastrointestinal and Endocrine Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390-9156, USA.
Ian C
IC
Mitchell
Richard J
RJ
Auchus
Kavita
K
Juneja
Alice Y
AY
Chang
Shelby A
SA
Holt
William H
WH
Snyder
Fiemu E
FE
Nwariaku
D000236:Adenoma / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D000302:Adrenal Cortex / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D000306:Adrenal Cortex Neoplasms / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003480:Cushing Syndrome / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
D006854:Hydrocortisone