What is subclinical cushing’s syndrome?
- subclinical hypercortisolism / may be observed with adrenal incidentaloma
- autonomous clucocorticoid production without specific signs and symptoms of Cushing’s syndrome.
- Much more common than classic Cushing’s syndrome
- Patients have a high prevalence of obesity, hypertension, and type 2 diabetes.
- Patients with incidentally detected adrenal masses who are about to undergo surgery should have testing for subclinical Cushing’s to avoid postoperative adrenal crisis..
- Best test is short dexamethasone suppression test.
What is Cushing’s syndrome?
- exaggerated facial roundness,
- weight gain around the midsection and upper back
- thinning of arms and legs.
- stretch marks
- Cushing’s syndrome occurs when exposed to high levels of the hormone cortisol for an extended period of time.
- this can either occur with taking too much corticosteroid medication or when the body makes too much cortisol.
- Pituitary adenoma – secreting excess ACTH which stimulates the adrenal glands to make more cortisol
- Ectopic ACTH secreting tumor (ie. Lungs, pancreas, thyroid or thymus gland)
- Primary Adrenal Gland disease
- Familial Cushing syndrome
Diabetes type 1 vs. type 2
Type 1 = immune disorder. Body attacks and destroys insulin producing beta cells in the pancreas. Must take insulin. Sometimes called insulin dependent or juvenile onset diabetes.
Type 2 = either the body doesn’t produce enough insulin or the cells ignore the insulin (resistant). Sometimes called adult onset diabetes. Obesity is the strongest risk factor for type 2 diabetes.
Adrenalectomy for subclinical Cushing’s Syndrome?
Adrenalectomy may lead to cure or better control of diseases associated with subclinical Cushing’s syndrome such as diabetes and hypertension
Most pose no clinical problems.