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New diagnostic criteria of adrenal subclinical Cushing’s syndrome: opinion from the Japan Endocrine Society

  • Yanase Toshihiko
    Department of Endocrinology and Diabetes Mellitus, Faculty of Medicine, Fukuoka University, Fukuoka 814-0180, Japan
  • Oki Yutaka
    Department of Community and Family Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
  • Katabami Takuyuki
    Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama 241-0811, Japan
  • Otsuki Michio
    Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita 565-0871, Japan
  • Kageyama Kazunori
    Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
  • Tanaka Tomoaki
    Department of Clinical Cell Biology and Medicine, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
  • Kawate Hisaya
    Department of Medicine and Bioregulatory Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan Department of Nutritional Sciences, Nakamura Gakuen University, Fukuoka 814-0198, Japan
  • Tanabe Makito
    Department of Endocrinology and Diabetes Mellitus, Faculty of Medicine, Fukuoka University, Fukuoka 814-0180, Japan
  • Doi Masaru
    Doi Clinic, Kumamoto 861-5255, Japan
  • Akehi Yuko
    Department of Endocrinology and Diabetes Mellitus, Faculty of Medicine, Fukuoka University, Fukuoka 814-0180, Japan
  • Ichijo Takamasa
    Department of Diabetes and Endocrinology, Saiseikai Yokohamashi Tobu Hospital, Yokohama 230-0012, Japan

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Abstract

<p>New diagnostic criteria and the treatment policy for adrenal subclinical Cushing’s syndrome (SCS) are proposed on behalf of the Japan Endocrine Society. The Japanese version has been published, and the essential contents are presented in this English-language version. The current diagnostic criteria for SCS have elicited two main problems: (i) the relatively low reliability of a low range of serum cortisol essential for the diagnosis by an overnight 1-mg dexamethasone suppression test (DST); (ii) different cutoff values for serum cortisol after a 1-mg DST compared with those of other countries. Thus, new criteria are needed. In the new criteria, three hierarchical cortisol cutoff values, 5.0, 3.0 and 1.8 μg/dL, after a 1-mg DST are presented. Serum cortisol ≥5 μg/dL after a 1-mg DST alone is considered sufficient to judge autonomous cortisol secretion for the diagnosis of SCS, and the current criterion based on serum cortisol ≥3 μg/dL after a 1-mg DST can continue to be used. Clinical evidence suggests that serum cortisol ≥1.8–2.9 μg/dL after a 1-mg DST is not always normal, so cases who meet the cutoff value as well as a basal adrenocorticotropic hormone (ACTH) level <10 pg/mL (or poor ACTH response to corticotropin-releasing hormone (CRH)) and nocturnal serum cortisol ≥5 μg/dL are proposed to have SCS. We suggest surgery if cases show serum cortisol ≥5 μg/dL after a 1-mg DST (or are disheartened by treatment-resistant problems) or suspicious cases of adrenal cancer according to tumor imaging.</p>

Journal

  • Endocrine Journal

    Endocrine Journal 65 (4), 383-393, 2018

    The Japan Endocrine Society

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