title: Pathophysiology and treatment of subclinical Cushing's disease and pituitary silent corticotroph adenomas [Review].
abstract: Pituitary adrenocorticotropic hormone (ACTH)-secreting tumor presents with a variety of clinical features. We outlined the features of ACTH release and characteristics of corticotroph adenoma cells. We especially focused on the corticotroph adenomas in patients with no clinical features of Cushing's disease. Subclinical Cushing's disease is defined by ACTH-induced mild hypercortisolism without typical features of Cushing's disease. Silent corticotroph adenomas (SCAs) are defined by normal cortisol secretion and ACTH-immunopositive staining without autonomous ACTH secretion. Clinicians who are not well-informed about the disease may sometimes confuse SCAs (because of their clinically silent nature) with "subclinical Cushing's disease". The recent criteria for diagnosing subclinical Cushing's disease in Japan are presented. Cortisol measurement was recently standardized in Japan, so plasma cortisol cutoff level should be reconsidered for the diagnosis. In patients with uncontrolled diabetes and hypertension despite appropriate treatment, subclinical Cushing's disease may be efficiently detected. Subclinical Cushing's disease may be associated with metabolic change. In subclinical Cushing's disease, mild hypercortisolism due to autonomous secretion of ACTH contributes to metabolic change and treatment of subclinical hypercortisolism can reverse this change.
authors: Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
authors: Kazunori
authors: K
authors: Kageyama
authors: Yutaka
authors: Y
authors: Oki
authors: Takeshi
authors: T
authors: Nigawara
authors: Toshihiro
authors: T
authors: Suda
authors: Makoto
authors: M
authors: Daimon
mesh_terms: D049913:ACTH-Secreting Pituitary Adenoma / Q000473:pathology* / Q000601:surgery; D000236:Adenoma / Q000473:pathology* / Q000601:surgery; D006801:Humans; D047748:Pituitary ACTH Hypersecretion / Q000473:pathology* / Q000601:surgery