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

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.

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