Endocrine Abstracts

Introduction

Subclinical Cushing’s syndrome (SCS) is an endocrine disorder characterized by an autonomous cortisol secretion in patients bearing adrenal adenomas in the absence of specific signs of hypercortisolism. The cortisol excess is known to be associated with metabolic comorbidities such as obesity, hypertension, glucose intolerance, and dyslipidemia increasing the incidence of cardiovascular events. The objective of this study was to describe the clinical and biochemical features in patients diagnosed with SCS and assess their metabolic and cardiovascular risk (CVR).

Methods

Medical charts of 40 patients diagnosed with SCS and who had been hospitalized between 1990 and 2020 in the Endocrinology Department of Hedi Chaker University Hospital, Sfax, Tunisia were reviewed. Clinical, biological, and radiological data were analyzed. The CVR was assessed using the SCORE charts.

Results:

Among our 40 patients, 57.5% were female. The average age of diagnosis was 56.82 ± 14.94 years. The 2-day low-dose Dexamethasone suppression test was adopted as a confirmatory endocrine work-up showing mean cortisol and ACTH levels of 68.93 ± 63.56 µg/l and at the 31.34 ± 34.47 pg/ml, respectively. The adrenal incidentalomas were unilateral in 76.4% and at the left side in 58.4%. The most common adrenal lesions were adenomas (73.7%) and hyperplasia (23.7%). The mean adenomas size was 3.17 ± 1.79 cm. A marked metabolic phenotype and insulin-resistance were featured in 82.5% of patients with 12.8% overweighted and 51.3% obese. Conspicuous abdominal fat distribution was noted in 75% of men and 90.9% of women with mean waist-circumferences of 97.88 and 104.82 cm respectively. Hypertension was encountered in 62.5% with a mean systolic blood pressure of 142.2 ± 12.11 mmHg. As for the glucose intolerance: 32.5% had type 2 diabetes mellitus and 35% presented with pre-diabetes. The mean fasting plasma glucose was 6.61 ± 1.77 mmol/l. Dyslipidemia affected 42.5%. The mean total-cholestérol and triglycerides levels were 5.51 ± 1.42 and 2.14 ± 1.98 mmol/l respectively. Considering the SCORE risk, three CVR categories were characterized: low, moderate, and high risk groups representing 37.5%, 30%, and 32.5% consecutively. Adrenalectomy was undergone in 40% of cases.

Conclusion

The SCS is linked to several pronounced metabolic comorbidities especially worsen glucose and lipid profile exposing to a higher CVR. The surgical or conservative management of this condition should be discussed on a case-by-case basis regarding the absence of widely accepted guidelines.