Tretyak O. Screening and diagnosis of subclinical hypercortisolism.

The thesis was based on the results of screening by determining the level of cortisol after 1 mg - DST in 252 patients with hypertension, obesity, and type 2 diabetes with the further step-by-step examination of 16 patients with confirmed hypercortisolism. The results of examination of 310 patients, who underwent surgery for unilateral/bilateral adrenal masses have been studied separately; and long-term results of surgical treatment of 30 patients with primary bilateral macronodular adrenal hyperplasia (PBMAH) have been evaluated. It`s been proven that the morbidity of subclinical hypercortisolism among patients with hypertension was 5.7%, in young patients with uncomplicated obesity it was 2.5%, in elderly patients with obesity complicated by type 2 diabetes and hypertension it was 6.25%. The most informative diagnostic test is cortisol 1 mg-DST and ACTH levels, in half of the cases of subclinical hypercortisolism, patients with hypertension also had PA. Having assessed the results of unilateral adrenalectomy in patients with subclinical hypercortisolism on the PBMAH, the weight loss, improved control of hypertension and diabetes mellitus in 80.4% of patients, no improvement in 6.6% of patients, recurrence in 13% of patients (36 months) have been confirmed. The above results substantiate the practicability of using a combined protocol for the diagnosis and treatment of subclinical hypercortisolism in patients with PBMAH, including the study of the presence of ectopic receptors in adrenal, unilateral adrenalectomy and pathogenetic therapy. The use of an integrated algorithm for the diagnosis of subclinical hypercortisolism in patients with adrenal incidentaloma, including the clinical and laboratory indicators, makes it possible to confirm or rule out subclinical hypercortisolism with a sensitivity of 94.9% and a specificity of 83.3%.