Six controversial issues on subclinical Cushing's syndrome

Area of Science:

• Endocrinology
• Internal Medicine
• Clinical Research

Background:

• Subclinical Cushing's syndrome (SCS) involves hypercortisolism without overt symptoms.
• It is associated with increased risks of diabetes, hypertension, fractures, cardiovascular events, and mortality.
• SCS prevalence is estimated at 0.2-2% in the adult population, yet controversies persist regarding its management.

Purpose of the Study:

• To present the viewpoint of the Altogether to Beat Cushing's syndrome Group on controversial issues in SCS.
• To address screening, diagnosis, and treatment strategies for SCS, particularly in patients with adrenal incidentalomas.
• To consolidate expert opinion on managing SCS based on available literature evidence.

Main Methods:

• Review and synthesis of existing literature on subclinical Cushing's syndrome.
• Expert consensus development by the Altogether to Beat Cushing's syndrome Group.
• Addressing specific controversial points including screening criteria, diagnostic methods for adrenal incidentalomas, associated complications, and therapeutic approaches.

Main Results:

• The literature evidence supports that subclinical Cushing's syndrome is a harmful condition.
• Current diagnostic tools are considered reliable for identifying most individuals with SCS.
• The group provides expert recommendations on screening, diagnosis, and management of SCS.

Conclusions:

• Subclinical Cushing's syndrome poses significant health risks and requires careful management.
• Despite study limitations, evidence supports the clinical relevance and diagnostic reliability of SCS assessment.
• This expert viewpoint aims to guide clinical practice in addressing controversial aspects of SCS.