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?Subclinical Cushing?s syndrome? is not subclinical: improvement after adrenalectomy in 9 patients


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  • Chief Cushie

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American Association of Endocrine Surgeons

 

?Subclinical Cushing?s syndrome? is not subclinical: improvement after adrenalectomy in 9 patients

 

Ian C. Mitchell MDa, Richard J. A. MD, PhDb, Kavita Juneja MDb, Alice Y. Chang MDb, Shelby A. Holt MDa, William H. Snyder III MDa and Fiemu E. Nwariaku MDa, Corresponding Author Contact Information, E-mail The Corresponding Author

 

aDivision of Gastrointestinal and Endocrine Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Tex

 

bDivision of Endocrinology and Metabolism, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Tex

 

Accepted 8 October 2007. Available online 6 December 2007.

 

Background

 

A subgroup of patients with adrenal cortisol hypersecretion fails to meet the biochemical criteria for Cushing?s syndrome. Appropriate therapy for this entity, subclinical Cushing?s syndrome (subclinical CS), is unclear. We examined outcomes for patients who underwent unilateral adrenalectomy for subclinical CS.

Methods

 

Between 2003 and 2006, all patients who underwent adrenalectomy for cortisol hypersecretion caused by an adrenal mass were examined. We analyzed biochemical, metabolic, and clinical outcomes.

Results

 

Overall, 24 patients underwent adrenalectomy for adrenal cortisol hypersecretion, of which 9 were found to have subclinical CS. Median serum cortisol was 2.0 ?g/dL (range, 1.1?6.1) after 1-mg overnight dexamethasone suppression testing. Suspicious clinical findings on preoperative examination included skin bruising, unexplained weight gain, proximal muscle weakness, abnormal fat pads, skin thinning, fatigue, and facial plethora. During a median follow-up period of 5 months (range, 1?30 months), all 8 patients with easy bruising noted resolution postoperatively. Fatigue improved in 4 of 5 patients, muscle weakness in 6 of 8 patients, and weight in 7 of 9 patients, with a median body mass index change of ?2.0 kg/m2 (range, ?7.1 to +0.5 kg/m2).

 

Conclusion

 

Adrenalectomy improves clinical and metabolic parameters for many patients with subclinical CS.

 

 

Corresponding Author Contact InformationReprint requests: Fiemu Nwariaku, MD, FACS, Department of Surgery, UTSWMC, 5323 Harry Hines Blvd, Dallas, Texas 75390-?9156.

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Can we get an "I told you so! Amen!!!"

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The hard part here is that this (and another recently published article) are looking at ADRENAL MASSES... it's still leaving those of us with pituitary lumps out in the cold.

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