Cardiovascular mortality in patients with subclinical Cushing

Area of Science:

• Endocrinology
• Cardiovascular Medicine
• Oncology

Background:

• Adrenal incidentalomas (AI) with subclinical hypercortisolism (SH) are linked to increased cardiovascular risk factors, events, and mortality.
• Current diagnostic criteria for SH remain debated, complicating treatment decisions for AI patients.

Purpose of the Study:

• To review the cardiovascular implications of AI with SH.
• To discuss the diagnostic challenges and therapeutic uncertainties in managing SH.
• To highlight the need for further research, including randomized trials, to guide treatment strategies.

Main Methods:

• Literature review of studies on adrenal incidentaloma and subclinical hypercortisolism.
• Analysis of cardiovascular risk factors, events, and mortality in affected patients.
• Evaluation of current treatment approaches and diagnostic methods.

Main Results:

• Patients with AI and SH exhibit a high prevalence of cardiovascular risk factors and events.
• Surgical removal of the adrenal mass can improve hypertension and diabetes in established SH, but effects in possible SH are unclear.
• Data on the impact of SH recovery on cardiovascular events are lacking.

Conclusions:

• The diagnosis and management of SH in AI patients require further investigation.
• Randomized studies are essential to predict surgical effectiveness using cortisol secretion indexes.
• Future research should focus on developing targeted therapies for cortisol secretion control.