title: Long-term study of subclinical Cushing's syndrome shows high prevalence of extra-adrenal malignancy in patients with functioning bilateral adrenal tumors.
abstract: Subclinical Cushing's syndrome (SCS) is characterized by subtle autonomous cortisol secretion from adrenal tumors without specific signs and symptoms of hypercortisolism. Patients with SCS have a high prevalence of "lifestyle-related diseases," such as hypertension, diabetes mellitus, dyslipidemia, and osteoporosis. Long-term follow-up of SCS patients is reportedly indispensable for establishing indications for surgical treatment of SCS. We performed a follow-up survey of 27 patients with SCS (median: 5.3 years) and compared those who had undergone surgical treatment (n=15) with those who had not (n=12). The mean diameter of tumors was 31 mm; 16 (59%) patients had unilateral lesions and 11 (41%) carried bilateral ones. In 67% and 60% of the treatment group, respectively, hypertension and diabetes mellitus improved. We also noticed that eight of 11 (73%) SCS patients with bilateral adrenal tumors had extra-adrenal malignancies in various tissues. Interestingly, among nine SCS patients who had malignancies, eight showed bilateral adrenal uptake in ¹³¹I-aldosterol scintigraphy. The results imply that surgical treatment can reduce cardiovascular risks in SCS patients. Screening for malignancy may be necessary in patients with bilateral adrenal tumors suspected of autonomous hypersecretion of cortisol from both sides.
authors.affiliation: Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
authors.forename: Hisaya
authors.initials: H
authors.lastname: Kawate
authors.forename: Michiko
authors.initials: M
authors.lastname: Kohno
authors.forename: Yayoi
authors.initials: Y
authors.lastname: Matsuda
authors.forename: Yuko
authors.initials: Y
authors.lastname: Akehi
authors.forename: Makito
authors.initials: M
authors.lastname: Tanabe
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Horiuchi
authors.forename: Keizo
authors.initials: K
authors.lastname: Ohnaka
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Nomura
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Yanase
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Takayanagi
mesh_terms: D000301:Adosterol; D000310:Adrenal Gland Neoplasms / Q000097:blood / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D000311:Adrenal Glands / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000473:pathology / Q000601:surgery; D000315:Adrenalectomy; D000368:Aged; D003480:Cushing Syndrome / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000378:metabolism*; D007457:Iodine Radioisotopes; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000453:epidemiology / Q000473:pathology; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000473:pathology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000473:pathology; D015995:Prevalence; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012720:Severity of Illness Index; D047368:Tumor Burden
chemical_list: D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals; D000301:Adosterol; D006854:Hydrocortisone