Adrenal incidentalomas and subclinical Cushing's syndrome

The issue of cortisol secretion by adrenal masses discovered incidentally in the course of evaluation for an unrelated reason (Subclinical Cushing's Syndrome) is among the most controversial and contentious issues in clinical endocrine practice. This derives from our relatively poor ability to accurately determine clinically those at increased risk among the majority who are not, the significant limitations of available diagnostic tests, the lack of a gold standard for diagnosis or even universally agreed criteria for diagnosis. A consensus for diagnostic criteria would be a good first step on which to base the kinds of studies needed to address our uncertainties. In the meantime, we must be careful to recognize the limitations of the current evidence avoid the pitfalls of overestimation of disease prevalence and of the benefits of therapy resulting from advances in diagnostic imaging and sophisticated laboratory testing. There remains an essential role for clinical judgment.