Cardiovascular risks and their long-term clinical outcome in patients with subclinical Cushing’s syndrome
Open accessAbstract
Although subclinical Cushing's syndrome has been commonly experienced, details of the clinical outcome and its indication for adrenalectomy have yet to be established. In the present study, we investigated the prevalence of cardiovascular risks, their clinical outcome during long-term follow up before and after adrenalectomy in 20 patients with subclinical Cushing's syndrome. We also correlated the hypercortisolism and age with the cardiovascular risks and the clinical outcome. The prevalence of hypertension, impaired glucose metabolism, dyslipidemia, and obesity was 45%, 65%, 65%, and 25%, respectively. In the non-operated group (n = 12), six patients (50%) showed deterioration of at least one of the cardiovascular risks. Four patients showed an increase of at least one risk, while none of the patients showed a decrease in the number of risks. One patient developed overt Cushing's syndrome. In the operated group (n = 10) including two operated patients of the non-operated group, eight patients (80%) showed an improvement of at least one of the cardiovascular risks after surgery and five patients (50%) showed a decrease of at least one risk. The prognosis in terms of the changes of the cardiovascular risks was significantly better in the operated group than in the non-operated group (p<0.001). Neither the hypercortisolism nor age correlated to the presence and the clinical outcome of the cardiovascular risks. The present study clearly demonstrated probability of deterioration during the clinical course and improvement after adrenal surgery in patients with subclinical Cushing's syndrome. Careful follow-up of the cardiovascular risks is therefore warranted. Adrenalectomy could be a treatment of choice despite the hypercortisolism and age of the patients, especially when the cardiovascular risks show signs of deterioration.
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Most studies of surgical intervention for ACS involve small numbers and are retrospective, uncontrolled, and lack randomization.
“Several studies have reported the outcome of surgical intervention but most involve small numbers and are retrospective, uncontrolled, and lack randomization (230,243,250-253,255) (Table 7).”
From Adrenal incidentaloma (2020) · cites this paper as [243]
A subsequent study of 10 subjects found after recovery from subclinical hypercortisolism improvement of blood pressure, metabolic control of diabetes, and dyslipidemia in 83%, 22%, and 67% of cases; in 12 conservatively treated subjects, hypertension, diabetes, and obesity worsened in 17%, 25%, and 17%.
“A subsequent study of 10 subjects found after recovery from SH an improvement of blood pressure, metabolic control of diabetes, and dyslipidemia in 83, 22, and 67% of cases, respectively, whereas in 12 conservatively treated subjects, hypertension, diabetes, and obesity worsened in 17, 25, and 17% of cases, respectively (96).”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [96]
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- Authors
- TSUIKI, M., TANABE, A., TAKAGI, S., NARUSE, M., & TAKANO, K.
- Affiliations
- Tokyo Women's Medical University (JP)
- Kyoto Medical Center (JP)
- National Hospital Organization Yokohama Medical Center (JP)
- Venue
- Endocrine Journal
- Publisher
- Japan Endocrine Society
- Published
- 2008
- Volume
- 55
- Issue
- 4
- Pages
- 737-745
- ISSN
- 0918-8959 (ISSN-L)
- 1348-4540
- OpenAlex
- W1996474101
- Cited by
- 97
- References
- 24
- Citations by year
- 2025: 3 · 2024: 2 · 2023: 8 · 2022: 3 · 2021: 4 · 2020: 5 · 2019: 7 · 2018: 6 · 2017: 2 · 2016: 4 · 2015: 8 · 2014: 7 · 2013: 5 · 2012: 7
- FWCI
- 6.28
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Endocrine Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Keywords
- subclinical Cushing's syndrome, cardiovascular risk factors, adrenalectomy, hypercortisolism, hypertension, impaired glucose metabolism, dyslipidemia, obesity, long-term clinical outcomes, overtreatment
- MeSH terms
- Adrenalectomy, Adult, Aged, Cardiovascular Diseases, Cushing Syndrome, Female, Humans, Hydrocortisone, Hypertension, Male, Middle Aged, Obesity, Retrospective Studies, Risk Factors, Body Mass Index, Treatment Outcome, Incidental Findings, Diabetes Complications, Dyslipidemias
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