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Актуальность и перспективные направления изучения проблемы субклинического синдрома Кушинга.

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Субклинический синдром Кушинга наиболее часто выявляется (от 5 до 25% случаев) среди инциденталом надпочечников. Клиническая значимость данного состояния была подтверждена многочисленными исследованиями, показавшими “метаболические последствия” хронической автономной гиперсекреции кортизола. Этим больным в большей степени, в сравнении с общей популяцией, свойственны такие проявления метаболического синдрома как ожирение, нарушение углеводного обмена, гипертония, что определяет их в группу высокого кардиоваскулярного риска. Все это требует от практикующих врачей тщательного обследования пациентов с инциденталомами надпочечников на предмет гормональной активности образования, а также определения показаний к проведению оперативного вмешательства. Однако единого мнения о тактике ведения этой группы пациентов не существует. Патогенез субклинического синдрома Кушинга остается неясным. Понимание механизмов развития кортизол-продуцирующих опухолей позволило бы выявить клинико-генетическую неоднородность данной когорты, определить прогноз заболевания и показания к проведению хирургической операции, разработать медикаментозные методы лечения. Целью этой обзорной статьи является рассмотрение современных взглядов на диагностику, патогенез и лечение субклинического синдрома Кушинга, определение перспективных направлений работы.

Ключевые слова:
субклинический синдром Кушинга, инциденталома, автономная гиперсекреция кортизола, метаболический синдром, генетика, эпигенетика, subclinical Cushing`s syndrome, autonomous cortisol hypersecretion, incidentalomas, metabolic syndrome, epigenetics, genetics

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Relevance and perspective concept of investigation of subclinical Cushing syndrome.

Subclinical Cushing’s syndrome is the most widespread variant of hormonal activity among adrenal incidentalomas. The clinical significance of this condition has been confirmed by numerous studies showing “metabolic consequences” of chronic autonomous cortisol hypersecretion. Some clinical symptomatology of metabolic syndrome, such as obesity, impaired carbohydrate metabolism and hypertension, are peculiar to subclinical hypercorticism more than to population. This requires a thorough examination of patients with adrenal incidentalomas for hormonal activity, as well as determining the indications for surgical intervention. In the current era of evidence-based medicine, the overall management of these tumors remains empirical. The pathogenesis of subclinical Cushing’s syndrome remains unclear. Understanding of the mechanisms of chronic autonomous cortisol hypersecretion would enable to identify clinical and genetic heterogeneity of this condition, to determine prognosis and indications for surgery and to develop pharmacological methods of treatment. The purpose of this article is to review the current views on the diagnosis, pathogenesis and treatment of subclinical Cushing’s syndrome, identifying perspective directions of work.

Keywords:
субклинический синдром Кушинга, инциденталома, автономная гиперсекреция кортизола, метаболический синдром, генетика, эпигенетика, subclinical Cushing`s syndrome, autonomous cortisol hypersecretion, incidentalomas, metabolic syndrome, epigenetics, genetics