Kageyama Kazunori, Oki Yutaka, Nigawara Takeshi, Suda Toshihiro, Daimon Makoto
Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
Endocr J. 2014;61(10):941-8. doi: 10.1507/endocrj.ej14-0120. Epub 2014 Jun 29.
Pituitary adrenocorticotropic hormone (ACTH)-secreting tumor presents with a variety of clinical features. We outlined the features of ACTH release and characteristics of corticotroph adenoma cells. We especially focused on the corticotroph adenomas in patients with no clinical features of Cushing's disease. Subclinical Cushing's disease is defined by ACTH-induced mild hypercortisolism without typical features of Cushing's disease. Silent corticotroph adenomas (SCAs) are defined by normal cortisol secretion and ACTH-immunopositive staining without autonomous ACTH secretion. Clinicians who are not well-informed about the disease may sometimes confuse SCAs (because of their clinically silent nature) with "subclinical Cushing's disease". The recent criteria for diagnosing subclinical Cushing's disease in Japan are presented. Cortisol measurement was recently standardized in Japan, so plasma cortisol cutoff level should be reconsidered for the diagnosis. In patients with uncontrolled diabetes and hypertension despite appropriate treatment, subclinical Cushing's disease may be efficiently detected. Subclinical Cushing's disease may be associated with metabolic change. In subclinical Cushing's disease, mild hypercortisolism due to autonomous secretion of ACTH contributes to metabolic change and treatment of subclinical hypercortisolism can reverse this change.
垂体促肾上腺皮质激素（ACTH）分泌肿瘤具有多种临床特征。我们概述了ACTH释放的特征和促肾上腺皮质激素腺瘤细胞的特性。我们特别关注无库欣病临床特征患者的促肾上腺皮质激素腺瘤。亚临床库欣病定义为ACTH诱导的轻度皮质醇增多症，且无库欣病的典型特征。静止性促肾上腺皮质激素腺瘤（SCA）定义为皮质醇分泌正常且ACTH免疫阳性染色但无自主性ACTH分泌。对该疾病了解不足的临床医生有时可能会将SCA（因其临床无症状）与“亚临床库欣病”混淆。本文介绍了日本近期诊断亚临床库欣病的标准。日本最近对皮质醇测量进行了标准化，因此应重新考虑用于诊断的血浆皮质醇临界值水平。在接受适当治疗后糖尿病和高血压仍未得到控制的患者中，可能会有效地检测出亚临床库欣病。亚临床库欣病可能与代谢变化有关。在亚临床库欣病中，ACTH自主性分泌导致的轻度皮质醇增多症会导致代谢变化，而亚临床高皮质醇血症的治疗可以逆转这种变化。
