Introduction

Although no definitive surgical guide line exist in Sub-clinical Cushing Syndrome: SCS, surgical resection is considered based on the presence of hyper tension(HT), diabetes mellitus(DM) and hyper lipidemia(HL). Cortisole(CS) level > 3μg/dL after use of 1mg dexamethasone(Dex) was the U.S. guideline of SCS, while >1.8µg/dL in Japanese guideline. In this analysis, we have studied the clinical benefit of surgically removal in SCS tumor, especially patients with gray zone(between US and Japanese guideline);1.8≤CS<3.0µg/dL after Dex 1mg treatment.

Methods

Total of 112 patients diagnosed as SCS between 1997 and 2015 were included in this study. 94 patients underwent surgical adrenalectomy and 18 patients were none surgically observed. Clinical outcome such as HT, DM, HL and body mass index(BMI) were retrospectively analyzed. All the surgical adrenalectomies were performed by retroperitoneal laparoscopic adrenalectomy.

Results

Median age was 65 years. Median tumor diameters were 30 mm. Significant improvement in HT (P<.0001), HbA1c (P=0.016) and BMI (P=0.0018) were observed in overall surgically removed SCS patients. Significant improvements in HT (P=0.034) and BMI (P=0.042) were also observed in 1.8≤CS<3.0µg/dL group after surgery. However, clinical improvement were more evident in ≥3.0µg/dL group, such as HT (P=0.0002), HbA1c (P=0.028) and HDL-C(P=0.046), while no clinical improvement were observed in ≤1.8µg/dL groups. Although not reached statistical significance, surgical removal groups tends to show the reduction in prescribed drugs compare to none surgical groups(drugs related to DM 23 vs 10% p=0.073, HT 37 vs 11% P=0.078 and HL 43% vs 11% P=0.282)

Conclusions

The current data showed that surgically removal of SCS tumor mediated significant improvements in the clinical symptoms. Based on expected clinical benefit,the gray zone SCS patients; 1.8≤CS<3.0µg/dL after Dex 1mg treatment may also be a optimal candidate for laparoscopic adrenalectomy.

Funding

None