Subclinical Hypercortisolism: How to Deal with It?

Area of Science:

• Endocrinology
• Internal Medicine
• Oncology

Background:

• Subclinical hypercortisolism (SH) involves mild cortisol excess in 5-30% of patients with adrenal incidentalomas.
• Adrenal incidentalomas are silent adrenal masses found incidentally during imaging for other conditions.
• SH lacks classical Cushing's syndrome symptoms but is associated with significant health risks.

Purpose of the Study:

• To review the diagnostic criteria for subclinical hypercortisolism.
• To discuss the associated metabolic and non-metabolic complications of SH.
• To explore the ongoing debate regarding the management of SH.

Main Methods:

• Review of diagnostic tests for SH, including dexamethasone suppression tests and urinary cortisol measurements.
• Analysis of literature linking SH to metabolic diseases, cardiovascular issues, osteoporosis, and mortality.
• Discussion of current management strategies and their outcomes.

Main Results:

• Diagnostic criteria for SH lack universal consensus, though several tests are commonly used.
• SH is associated with type 2 diabetes, hypertension, obesity, dyslipidemia, cardiovascular disease, and osteoporosis.
• Increased mortality and reduced quality of life are reported in SH patients.

Conclusions:

• Subclinical hypercortisolism presents a diagnostic challenge due to a lack of consensus criteria.
• Despite being subclinical, SH is linked to serious comorbidities and increased mortality.
• Further research is needed to establish definitive diagnostic and management guidelines for SH.