The Recovery of Hypothalamic-Pituitary-Adrenal Axis Is Rapid in Subclinical Cushing Syndrome
BackgroundIn subclinical Cushing syndrome (SC), it is assumed that glucocorticoid production is insufficient to cause a clinically recognizable syndrome. Differences in hormonal levels or recovery time of the hypothalamic-pituitary-adrenocortical (HPA) axis after adrenalectomy between patients with...
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Korean Endocrine Society
2016-12-01
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| Series: | Endocrinology and Metabolism |
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| Online Access: | http://e-enm.org/Synapse/Data/PDFData/2008ENM/enm-31-592.pdf |
| _version_ | 1818354695685537792 |
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| author | Hee Kyung Kim Jee Hee Yoon Yun Ah Jeong Ho-Cheol Kang |
| author_facet | Hee Kyung Kim Jee Hee Yoon Yun Ah Jeong Ho-Cheol Kang |
| author_sort | Hee Kyung Kim |
| collection | DOAJ |
| description | BackgroundIn subclinical Cushing syndrome (SC), it is assumed that glucocorticoid production is insufficient to cause a clinically recognizable syndrome. Differences in hormonal levels or recovery time of the hypothalamic-pituitary-adrenocortical (HPA) axis after adrenalectomy between patients with overt Cushing syndrome (OC) and SC remain unknown.MethodsThirty-six patients (10 with OC and 26 with SC) with adrenal Cushing syndrome who underwent adrenalectomy from 2004 to 2014 were reviewed retrospectively. Patients were treated with glucocorticoid after adrenalectomy and were reevaluated every 1 to 6 months using a rapid adrenocorticotropic hormone (ACTH) stimulation test.ResultsLevels of basal 24-hour urine free cortisol (UFC), serum cortisol after an overnight dexamethasone suppression test (DST), and serum cortisol and 24-hour UFC after low-dose DST and high-dose DST were all significantly lower in patients with SC compared with OC. Basal ACTH levels showed significantly higher in patients with SC compared with OC. The probability of recovering adrenal function during follow-up differed significantly between patients with OC and SC (P=0.001), with significant correlations with the degree of preoperative cortisol excess. Patients with OC required a longer duration of glucocorticoid replacement to recover a normal ACTH stimulation test compared with patients with SC (median 17.0 months vs. 4.0 months, P<0.001).ConclusionThe HPA axis recovery time after adrenalectomy in patients with SC is rapid and is dependent on the degree of cortisol excess. More precise definition of SC is necessary to achieve a better management of patients and to avoid the risk of under- or over-treatment of SC patients. |
| first_indexed | 2024-12-13T19:29:31Z |
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| id | doaj.art-2a21d9c701c94530ae119ff6e05129b5 |
| institution | Directory Open Access Journal |
| issn | 2093-596X 2093-5978 |
| language | English |
| last_indexed | 2024-12-13T19:29:31Z |
| publishDate | 2016-12-01 |
| publisher | Korean Endocrine Society |
| record_format | Article |
| series | Endocrinology and Metabolism |
| spelling | doaj.art-2a21d9c701c94530ae119ff6e05129b52022-12-21T23:33:58ZengKorean Endocrine SocietyEndocrinology and Metabolism2093-596X2093-59782016-12-0131459259710.3803/EnM.2016.31.4.59221722The Recovery of Hypothalamic-Pituitary-Adrenal Axis Is Rapid in Subclinical Cushing SyndromeHee Kyung KimJee Hee YoonYun Ah JeongHo-Cheol KangBackgroundIn subclinical Cushing syndrome (SC), it is assumed that glucocorticoid production is insufficient to cause a clinically recognizable syndrome. Differences in hormonal levels or recovery time of the hypothalamic-pituitary-adrenocortical (HPA) axis after adrenalectomy between patients with overt Cushing syndrome (OC) and SC remain unknown.MethodsThirty-six patients (10 with OC and 26 with SC) with adrenal Cushing syndrome who underwent adrenalectomy from 2004 to 2014 were reviewed retrospectively. Patients were treated with glucocorticoid after adrenalectomy and were reevaluated every 1 to 6 months using a rapid adrenocorticotropic hormone (ACTH) stimulation test.ResultsLevels of basal 24-hour urine free cortisol (UFC), serum cortisol after an overnight dexamethasone suppression test (DST), and serum cortisol and 24-hour UFC after low-dose DST and high-dose DST were all significantly lower in patients with SC compared with OC. Basal ACTH levels showed significantly higher in patients with SC compared with OC. The probability of recovering adrenal function during follow-up differed significantly between patients with OC and SC (P=0.001), with significant correlations with the degree of preoperative cortisol excess. Patients with OC required a longer duration of glucocorticoid replacement to recover a normal ACTH stimulation test compared with patients with SC (median 17.0 months vs. 4.0 months, P<0.001).ConclusionThe HPA axis recovery time after adrenalectomy in patients with SC is rapid and is dependent on the degree of cortisol excess. More precise definition of SC is necessary to achieve a better management of patients and to avoid the risk of under- or over-treatment of SC patients.http://e-enm.org/Synapse/Data/PDFData/2008ENM/enm-31-592.pdfSubclinical Cushing syndromeOvert Cushing syndromeAdrenal incidentalomaHydrocortisoneHypothalamic-pituitary-adrenocortical axis recovery |
| spellingShingle | Hee Kyung Kim Jee Hee Yoon Yun Ah Jeong Ho-Cheol Kang The Recovery of Hypothalamic-Pituitary-Adrenal Axis Is Rapid in Subclinical Cushing Syndrome Endocrinology and Metabolism Subclinical Cushing syndrome Overt Cushing syndrome Adrenal incidentaloma Hydrocortisone Hypothalamic-pituitary-adrenocortical axis recovery |
| title | The Recovery of Hypothalamic-Pituitary-Adrenal Axis Is Rapid in Subclinical Cushing Syndrome |
| title_full | The Recovery of Hypothalamic-Pituitary-Adrenal Axis Is Rapid in Subclinical Cushing Syndrome |
| title_fullStr | The Recovery of Hypothalamic-Pituitary-Adrenal Axis Is Rapid in Subclinical Cushing Syndrome |
| title_full_unstemmed | The Recovery of Hypothalamic-Pituitary-Adrenal Axis Is Rapid in Subclinical Cushing Syndrome |
| title_short | The Recovery of Hypothalamic-Pituitary-Adrenal Axis Is Rapid in Subclinical Cushing Syndrome |
| title_sort | recovery of hypothalamic pituitary adrenal axis is rapid in subclinical cushing syndrome |
| topic | Subclinical Cushing syndrome Overt Cushing syndrome Adrenal incidentaloma Hydrocortisone Hypothalamic-pituitary-adrenocortical axis recovery |
| url | http://e-enm.org/Synapse/Data/PDFData/2008ENM/enm-31-592.pdf |
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