Subclinical Cushing´s syndrome in outpatients attending an University Hospital

ALEJANDRO L. ARREGGER, ESTELA ML CARDOSO, ALICIA ELBERT, ELIDA G MONARDES TUMILASCI, LILIANA N. CONTRERAS

San Diego, USA

Congreso; 92 Annual M eeting Endocrine Society; 2010

Endorcine Society

Subclinical Cushing´s syndrome in outpatients attending an University Hospital. Alejandro L Arregger1, Estela ML Cardoso1,2,3, Alicia Elbert4, Elida G Monardes Tumilasci3, Liliana N. Contreras1,2. Endocrine Research Department, University of Buenos Aires1; CONICET2; Laboratory of Salivary Glands, University of Buenos Aires3, CEREHA4 Preclinical Cushing¡¯s syndrome is defined as endogenous cortisol excess in the absence of  a cushingoid appearance. We screened  59  adult patients with  a) diabetes mellitus (DM) with  poor glycemic  control ( DM type1 n=7,  2 men, 5 women, aged 29-52 y.o. ; DM type 2 n=23 , 11 men and 12 women, 52-64 y.o); b)incidental adrenal masses ( n=12; 3 men and 9 women, 38.0-68.0 y.o.); c) high blood pressure and central obesity ( n=10, 4 men and 6 women ,18-69 y.o), d)hirsutism (n=5, 24-63 y.o) and e) kidney stones( n=2, 1 man and 1 woman, 20 and 30 y.o).None of them had clinical appearance of  Cushing¡¯s Syndrome (CS) and were free of drugs interfering the hypothalamic- pituitary -adrenal function  and/or dexamethasone metabolism. All subjects collected  two 24 hour urine specimens for total urinary cortisol (UFC) and creatinine masurements. Salivary samples were obtained at 8 h and 23 h in two non-consecutive days  for salivary cortisol assessment ( SAF8 and SAF 23, respectively ). In all non  diabetic patients morning salivary ( SAF dex)and serum cortisol (F dex) was determined after overnight oral 1 mg dexamethasone suppression test. Salivary ,serum  and urinary cortisol were assayed by RIA (1,2). Reference values obtained from 121 healthy volunteers and 21 confirmed CS were UFC < 248 nM/day; SAF < 18 nM; SAF 23< 3.8 nM; SAF dex ¡Â 2.0 nM; Fdex ¡Â 50nM. Results: Cortisol excess was detected in 3 women. Data are displayed in the following Table. Patient # Age UFC (nM/day) SAF8(nM) SAF23(nM) SAFdex (nM) Fdex (nM) 1 29 363.0; 240.0 6.5; 6.0 5.0 ; 4.5 7.0 414.0 2 34 2004.0; 650.0 14.0; 15.0 13.0; 12.0 6.0 275.0 3 49 200.0; 190.0 6.5; 7.0 1.5; 0.8 2.0 63.0 #1 and #2: high blood pressure and central obesity; #3: incidental adrenal mass. ACTH values were 20 pg/ml (# 1) and 27 pg/ml ( # 2 ) . Petrosal sinus sampling confirmed the central source of ACTH  in both . Transphenoidal pituitary exploration showed the presence of a microadenoma in #1 and hyperplasia in #2. They became hypocortisolemic after surgery. ACTH was less than 10 pg/ml in patient#3. After right adrenalectomy histology described a cortical adrenal adenoma. This study stresses the importance of  searching  cortisol excess in outpatients with non-specific symptoms of CS. In our experience the initial evaluation with  more than one first line screening test improved the diagnostic performance. References: 1 . Assessment of corticoadrenal reserve through salivary steroids. Cardoso E, Persi G, Arregger AL, Contreras LN. The Endocrinologist 2002; 13: 459-464 2. Diagnostic value of salivary cortisol in Cushing¢¥s syndrome. Cardoso EML, Arregger AL, Tumilasci O, Contreras LN. Clin Endocrinol (Oxf) 2009, 70 (4): 516-521