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.

journal_name

Endocr J

journal_title

Endocrine journal

authors

Kageyama K,Oki Y,Nigawara T,Suda T,Daimon M

doi

10.1507/endocrj.ej14-0120

subject

Has Abstract

pub_date

2014-01-01 00:00:00

pages

941-8

issue

10

eissn

0918-8959

issn

1348-4540

pii

DN/JST.JSTAGE/endocrj/EJ14-0120

journal_volume

61

pub_type

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