title: Clinical significance of screening for subclinical Cushing's disease in patients with pituitary tumors.
abstract: Cushing's syndrome (CS) is a clinical state caused by chronic excess of glucocorticoid, and results in hypertension, impaired glucose tolerance, and dyslipidemia. Recently, a mild state of pituitary CS without typical Cushingoid appearance (subclinical Cushing's disease; SCD) has been identified. However, the true prevalence of SCD and its effect on metabolic disorders remain obscure. The aim of this prospective study was to determine the prevalence of SCD according to the guideline proposed by the working group of the Japanese Ministry of Health, Welfare and Labor, and to assess the outcome of surgery on metabolic disorders. The prevalence of SCD was investigated in 105 consecutive patients diagnosed with pituitary adenomas by MRI. ACTH-dependent hypercortisolism was diagnosed based on the results of the 0.5 mg dexamethasone suppression test (serum cortisol >3.0 μg/dL) plus one positive finding of the following two tests: midnight serum cortisol level >5.0 μg/dL or ACTH increase >50% after 1-deamino-5-D-arginine vasopressin (DDAVP) challenge. The final diagnosis of SCD was established by positive staining for ACTH in surgically-excised pituitary adenoma. Three patients (4.8%) were diagnosed with SCD among 62 patients with pituitary adenoma. Transsphenoidal adenomectomy partially resulted in improvement of blood pressure and glucose metabolism in SCD patients. Our results emphasize the importance of SCD screening in patients with pituitary tumors, especially in those patients with metabolic disorders.
authors.affiliation: Departments of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Tamada
authors.forename: Tetsuhiro
authors.initials: T
authors.lastname: Kitamura
authors.forename: Michio
authors.initials: M
authors.lastname: Otsuki
authors.forename: Satoru
authors.initials: S
authors.lastname: Oshino
authors.forename: Youichi
authors.initials: Y
authors.lastname: Saitoh
authors.forename: Iichiro
authors.initials: I
authors.lastname: Shimomura
mesh_terms: D049913:ACTH-Secreting Pituitary Adenoma / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D000236:Adenoma / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D000324:Adrenocorticotropic Hormone / Q000032:analysis / Q000097:blood*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases; D006801:Humans; D008279:Magnetic Resonance Imaging; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D047748:Pituitary ACTH Hypersecretion / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D015995:Prevalence; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000324:Adrenocorticotropic Hormone