New diagnostic criteria of adrenal subclinical Cushing’s syndrome: opinion from the Japan Endocrine Society

Endocrine journal

Tomoaki Tanaka¹  Yutaka Oki²  Toshihiko Yanase³  Kazunori Kageyama⁴  Hisaya Kawate⁵  Michio Otsuki⁶  Makito Tanabe⁷  Takuyuki Katabami⁸  Masaru Doi⁹ 

[1] Department of Clinical Cell Biology and Medicine, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan;Department of Community and Family Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan;Department of Endocrinology and Diabetes Mellitus, Faculty of Medicine, Fukuoka University, Fukuoka 814-0180, Japan;Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan;Department of Medicine and Bioregulatory Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan;Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita 565-0871, Japan;Department of Nutritional Sciences, Nakamura Gakuen University, Fukuoka 814-0198, Japan;Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama 241-0811, Japan;Doi Clinic, Kumamoto 861-5255, Japan

关键词: Subclinical Cushing’s syndrome;    Adrenal tumor;    Cortisol;    Adrenocorticotropic hormone;    Dexamethasone suppression test;   

DOI  :  10.1507/endocrj.EJ17-0456

学科分类：内分泌与代谢学

来源: Japan Endocrine Society

【 摘 要 】

New diagnostic criteria and the treatment policy for adrenal subclinical Cushing’s syndrome (SCS) are proposed on behalf of the Japan Endocrine Society. The Japanese version has been published, and the essential contents are presented in this English-language version. The current diagnostic criteria for SCS have elicited two main problems: (i) the relatively low reliability of a low range of serum cortisol essential for the diagnosis by an overnight 1-mg dexamethasone suppression test (DST); (ii) different cutoff values for serum cortisol after a 1-mg DST compared with those of other countries. Thus, new criteria are needed. In the new criteria, three hierarchical cortisol cutoff values, 5.0, 3.0 and 1.8 μg/dL, after a 1-mg DST are presented. Serum cortisol ≥5 μg/dL after a 1-mg DST alone is considered sufficient to judge autonomous cortisol secretion for the diagnosis of SCS, and the current criterion based on serum cortisol ≥3 μg/dL after a 1-mg DST can continue to be used. Clinical evidence suggests that serum cortisol ≥1.8–2.9 μg/dL after a 1-mg DST is not always normal, so cases who meet the cutoff value as well as a basal adrenocorticotropic hormone (ACTH) level <10 pg/mL (or poor ACTH response to corticotropin-releasing hormone (CRH)) and nocturnal serum cortisol ≥5 μg/dL are proposed to have SCS. We suggest surgery if cases show serum cortisol ≥5 μg/dL after a 1-mg DST (or are disheartened by treatment-resistant problems) or suspicious cases of adrenal cancer according to tumor imaging.

【 授权许可】

Unknown