PRECLINICAL CUSHINGS-SYNDROME - REPORT OF 3 CASES AND LITERATURE-REVIEW

Pre-Cushing's syndrome (PCS) is defined as an overproduction of cortis ol by an adrenal adenoma, without physical changes on clinical examina tion. Three patients with PCS were recently diagnosed among 21 consecu tive patients suffering from adrenal 'incidentaloma'. Ah patients show ed nonsuppression of serum and urinary cortisol following 2 and 8 mg o f dexamethasone (DXM), and suppressed or normal baseline plasma ACTH. Unilateral uptake of radiolabelled iodocholesterol, which persisted af ter DXM, was uniformly present. The authors review 36 patients with PC S previously reported. This entity probably constitutes a transition f rom classic 'nonfunctional' adrenal adenoma to cortisol-producing aden oma. Uniform guidelines in the management of PCS cannot yet be given, but surgical intervention is usually required to prevent the developme nt of long-term complications of subtle corticoid excess.