094 - Subclinical Hypercortisolism: How And When To Screen For It?
Autor(s): R. Castello, F. Zambotti
Issue: RIMeL - IJLaM, Vol. 6, N. 3-S1, 2010 (MAF Servizi srl ed.)
Page(s): 94-96
Subclinical hypercortisolism is the presence of an alteration in cortisol secretion in the absence of clinical features of Cushing’s syndrome. It has a prevalence of 5-20% in literature and it has been demostrated to be particularly frequent in some populations of patients, such as those with type 2 diabetes, hypertension, elder people with osteoporosis and vertebral fractures. Demonstrating biochemical hypercortisolism can be challenging because the common methods used in overt Cushing’s syndrome are less effective in modest hypercortisolism as well as it is for ACTH assays if ACTH is on the lower normal range. There is no wide consensus on the best laboratory test to diagnose subclinical Cushing’s syndrome (midnight salivary cortisol levels, free urinary cortisol, suppression test, etc.). Among these assays the best seems to be 1 mg desametasone overnight suppression test using 2 mg/die x 48 h in presence of obesity, alcoholism, psychiatric pathologies or diabetes. Also the diagnostic cutt-off is still a matter of debate, though it’s seem reasonable to set it at 1,8 ug/dL (50 nmol/L). A chronic cortisol excess, even if low, may have important effects such as metabolic alterations, insulin resistance syndrome, cardiovascular complications and osteoporotic fractures. Screening for Cushing’s syndrome is indicated in presence of adrenal incidentalomas, age unexpected disease (early development of hypertension or osteoporosis), cushingoid clinical signs, children with low height increase and overweight. It may be considered also in those patient populations in which it is demonstrated a high prevalence such as patients with diabetes, hypertension or osteoporosis.