The Recovery of Hypothalamic-Pituitary-Adrenal Axis Is Rapid in Subclinical Cushing Syndrome

Abstract

BackgroundIn subclinical Cushing syndrome (SC), it is assumed that glucocorticoid production is insufficient to cause a clinically recognizable syndrome. Differences in hormonal levels or recovery time of the hypothalamic-pituitary-adrenocortical (HPA) axis after adrenalectomy between patients with overt Cushing syndrome (OC) and SC remain unknown.MethodsThirty-six patients (10 with OC and 26 with SC) with adrenal Cushing syndrome who underwent adrenalectomy from 2004 to 2014 were reviewed retrospectively. Patients were treated with glucocorticoid after adrenalectomy and were reevaluated every 1 to 6 months using a rapid adrenocorticotropic hormone (ACTH) stimulation test.ResultsLevels of basal 24-hour urine free cortisol (UFC), serum cortisol after an overnight dexamethasone suppression test (DST), and serum cortisol and 24-hour UFC after low-dose DST and high-dose DST were all significantly lower in patients with SC compared with OC. Basal ACTH levels showed significantly higher in patients with SC compared with OC. The probability of recovering adrenal function during follow-up differed significantly between patients with OC and SC (P=0.001), with significant correlations with the degree of preoperative cortisol excess. Patients with OC required a longer duration of glucocorticoid replacement to recover a normal ACTH stimulation test compared with patients with SC (median 17.0 months vs. 4.0 months, P<0.001).ConclusionThe HPA axis recovery time after adrenalectomy in patients with SC is rapid and is dependent on the degree of cortisol excess. More precise definition of SC is necessary to achieve a better management of patients and to avoid the risk of under- or over-treatment of SC patients.

Is Prophylactic Steroid Treatment Mandatory for Subclinical Cushing Syndrome After Unilateral Laparoscopic Adrenalectomy?

“…It was remarkable that at three months after surgery, when the stressful condition was still not present, 35 morning plasma cortisol was > 5 mg/dL in all patients, regardless of the preoperative cortisol degree, and such a level implies the recovery of the HPA axis. 28,37 The present results confirm that there is no clear correlation between recovery time and preoperative cortisol levels. 32 Since a residual adrenal tissue of approximately 10% to 15% offers intact stress capacity 38 and the morphology of the contralateral adrenal glands in the present study were normal, it is reasonable to presume that the volume of residual adrenal tissue, rather than the degree of cortisol secretion, played a crucial role in the time to restoration of eucortisolism, although this finding is limited by the sample size and lack of control of the study.…”

Contralateral adrenal width predicts the duration of prolonged post‐surgical steroid replacement for subclinical Cushing syndrome

“…In this present study, we focused on only SCS patients. Some studies stated that prolonged adrenal insufficiency is more frequent in CS patients than in SCS patients . As CS is symptomatic, the duration of potential morbidity might be shorter than SCS.…”

“…Some studies stated that prolonged adrenal insufficiency is more frequent in CS patients than in SCS patients. [20][21][22] As CS is symptomatic, the duration of potential morbidity might be shorter than SCS. In addition, the recovery of the HPA axis might depend on the activity of the tumor itself.…”

Hypothalamic–pituitary–adrenal axis recovery after treatment of Cushing's syndrome

“…The mean recovery time was 6.5 months (range 1–50) in MACE and 11.2 months (range 1–60) in overt CS with a tight relationship between the degree of hypercortisolism and the time to recovery 3 . Kim et al 22 also reported that the recovery time was significantly shorter in patients with MACE than those with overt adrenal CS (4.0 months vs. 17.0 months).…”