Subclinical hypercortisolism: a state, a syndrome, or a disease?

Area of Science:

• Endocrinology
• Internal Medicine
• Cardiology

Background:

• Subclinical hypercortisolism (SH) involves hypothalamus-pituitary-adrenal axis dysfunction without overt symptoms.
• It is frequently observed in patients with adrenal incidentalomas.
• Understanding SH comorbidities and outcomes is critical for patient management.

Purpose of the Study:

• To review and summarize the comorbidities and clinical outcomes associated with SH.
• To consolidate current knowledge on the long-term health implications of SH.

Main Methods:

• Systematic review of studies published within the last 15 years.
• Analysis of clinical data focusing on comorbidities and long-term outcomes.
• Inclusion of findings from longitudinal and independent reports.

Main Results:

• Hypertension (approx. 2/3) and type 2 diabetes (approx. 1/3) are common in SH patients.
• Increased cardiovascular risk factors include endothelial damage, visceral fat, and lipid metabolism issues.
• SH patients exhibit higher incidence of cardiovascular events, mortality, and osteoporotic vertebral fractures.

Conclusions:

• SH is associated with substantial cardiovascular, metabolic, and skeletal complications.
• Improved diagnostic accuracy for SH is needed, potentially via comprehensive steroid profiling.
• Further research, including randomized trials, is required to establish optimal treatment strategies (surgical vs. medical).