Endocrine Abstracts

Introduction: Subclinical Cushing’s syndrome refers to autonomous cortisol secretion in patients who do not have the typical signs and symptoms of hypercortisolism. This study was undertaken to describe clinical, biological and radiological features of this disease and to evaluate the clinical outcome after surgical and medical treatment.

Methods: Retrospective study conducted over a period of 12 years and including 17 patients hospitalised in our department of endocrinology for subclinical Cushing’s syndrome.

Results: The average age of our patients was 58.94 years (38–77) with a sex ratio (M/F) of 1.12. The average waist circumference was 99.05 cm (range: 80–134). Obesity was found for 46% of patients, overweight for 54% of patients. The response of dexamethasone suppression test (2 mg) was altered for all patients. Urinary free cortisol was dosed for four patients (23.5%), normal in three cases (75%) and high in one case (25%). The mean level of ACTH was 20.21 ng/l (10–39.7). The adrenal CT showed an unilateral adenoma for 82%, bilateral adrenal hyperplasia for 12% and two right adrenal adenoma for 6% of cases. The repercussions of subclinical Cushing’s syndrome were HTA for 47.05%, dyslipidaemia for 23.5%, diabetes for 23.52%, impaired glucose tolerance for 29.41%, metabolic syndrome for 41.17%, obesity for 46% and hypokalaemia for 11.7% of cases. 58.8% of patients were operated, 50% of them presented adrenal insufficiency, all patients presented an improvement of anthropometric parameters and regression dyslipidaemia. 33% presented an improvement in hypertension and 28.57% presented a regression of diabetes. Conservative management was decided for 23.52% of patients, their evolution, with a mean follow of 4.75 years (3–7), showed an aggravation of diabetes for 50% and aggravation of dyslipidaemia for 50% of cases. No one presented an evolution to a Cushing. 17.64% were lost of follow up.

Conclusion: Adrenal surgery appears to be beneficial in case of pre-Cushing’ syndrome for both metabolic and cardiovascular complications.