[Subclinical Cushing's syndrome:analysis of diagnosis and surgical effect].
OBJECTIVE
To improve the diagnostic and therapeutic ability on subclinical Cushing's syndrome.


METHODS
Retrospective analysis for the clinical data of 24 cases of subclinical Cushing's syndrome, the clinical and biological characters pre and post operation were compared.


RESULTS
None of the 24 cases of subclinical Cushing's syndrome had the classic symptoms and signs of Cushing's syndrome. The common symptoms of these patients were hypertension in 17 cases, diabetes mellitus in 11 cases, hyperlipidemia in 9 cases, high plasma cortisol value in 13 cases and high 24 h UFC value in 9 cases. None of patients did respond to low dose dexamethasone suppression test, but 16 cases of them did not respond to high dose dexamethasone suppression test. All the cases were found adrenal tumors by CT scan, 10 cases in left adrenal and 14 cases in right adrenal. All the patients underwent retroperitoneal laparoscopic operation and were pathologic diagnosed to adrenal adenomas. During follow-up, the symptoms of 20 cases (83.3%) were cured after surgery, and hormone supplement was required in 8 cases.


CONCLUSIONS
Subclinical Cushing's syndrome may be incidentally detected on clinical manifestations, laboratory findings and imaging examinations. CT scan, assays of plasma cortisol, urinary free cortisol and dexamethasone suppression test are most useful in the diagnosis. The potential benefit of surgery should be considered in those who have a definite diagnosis of subclinical Cushing's syndrome. Hormone supplement is required in some patients. It is safe and practical to perform retroperitoneal laparoscopic surgery on the patients with subclinical Cushing's syndrome.
Feng
Chao
C
Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Li
Han-Zhong
HZ
Xiao
He
H
Yan
Wei-Gang
WG
Li
Yong-Qiang
YQ
Xu
Wei-Feng
WF
D000306:Adrenal Cortex Neoplasms / Q000150:complications / Q000601:surgery; D000315:Adrenalectomy / Q000379:methods; D018246:Adrenocortical Adenoma / Q000150:complications / Q000601:surgery; D000328:Adult; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome