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Субклинический синдром Кушинга, обусловленный одно- и двусторонними образованиями надпочечников. Проблемы диагностики и показаний к хирургическому лечению. Обзор литературы

Кузнецов Н. С., Тихонова О. В.
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Кузнецов Николай Сергеевич - д.м.н., профессор, заведующий отделением хирургии ФГБУ ''''Эндокринологический научный центр'''', ФГБУ ''''Эндокринологический научный центр'''' Минздрава России, Москва,
Тихонова Ольга Владимировна - ФГБУ ''''Эндокринологический научный центр'''' Минздрава России, Москва, helgatikhonova@yandex.ru,

Субклинический синдром Кушинга, по результатам многих исследований, является одним из самых распространенных вариантов гормональной активности случайно найденной опухоли надпочечников. Данная патология определяется как автономная гиперсекреция кортизола малой интенсивности, которая не приводит к развитию специфических признаков гиперкортицизма, однако биохимическими методами выявляются нарушения в гипоталамо-гипофизарно-надпочечниковой системе. Больным с субклиническим гиперкортицизмом в большей степени, чем общей популяции, свойственны некоторые проявления метаболического синдрома, такие как ожирение, нарушение углеводного обмена, гипертония. Все эти явления в итоге могут привести к повышению рисков сердечно-сосудистых осложнений. До сих пор в мире нет определенного мнения по поводу необходимости оперативного лечения данной патологии, хотя имеются доказательства, что после удаления образования надпочечника появляются улучшения проявлений метаболического синдрома. Для понимания всех возможных рисков, связанных с наличием субклинического гиперкортицизма, необходимо разобрать причины их возникновения, а также предоставить наиболее подходящие скрининговые тесты для выявления гиперсекреции кортизола малой интенсивности.

Ключевые слова:
субклинический синдром Кушинга, инциденталома, автономная гиперсекреция кортизола, метаболический синдром, subclinical Cushing''s syndrome, autonomous Cortisol hypersecretion, incidentalomas, metabolic syndrome

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Subclinical Cushing''s syndrome due to unilateral or bilateral adrenal incidentalomas. Problems of diagnostic and indication to surgical treatment. Review of literature

Kuznetsov N.S., Tikhonova O.V.

Today subclinical Cushing''s syndrome is the most widespread variant of hormonal activity of incidentaloma''s hormonal activity. This pathology is defined as a mild intensity autonomous cortisol hypersecretion, not causing specific clinical signs of hypercorticism, but detectable biochemically as derangements of the hypothalamic-pituitary-adrenal axis function. Some clinical symptomatology of metabolic syndrome, such as obesity, impaired carbohydrate metabolism and hypertension, are peculiar to subclinical hypercorticism more than to population. As a result all these symptomatology could lead to increasing cardiovascular risk. Till now there isn''t a definite opinion about the need of surgical treatment of present pathology. But there is evidence, that after removing of incidentalomas clinical symptomatology of metabolic syndrome are improving. For understanding all possible risks, connected with subclinical hypercorticism, it''s necessary to study the origins of their arising and present about the most adequate screening tests

Keywords:
субклинический синдром Кушинга, инциденталома, автономная гиперсекреция кортизола, метаболический синдром, subclinical Cushing''s syndrome, autonomous Cortisol hypersecretion, incidentalomas, metabolic syndrome

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ООО Издательский дом ВИДАР-М, 2024