Recent Advances on Subclinical Hypercortisolism
Guido Zavatta1, Guido Di Dalmazi1
1Division of Endocrinology, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, Bologna 40138, Italy.
Summary
Subclinical hypercortisolism in adrenal incidentalomas is linked to increased cardiovascular risks. Early detection via testing and monitoring, alongside potential surgery, may improve outcomes for affected patients.
Area of Science:
- Endocrinology
- Cardiovascular Medicine
- Oncology
Background:
- Adrenal incidentalomas are common findings, often asymptomatic.
- Subclinical hypercortisolism (SH) associated with these tumors presents a growing clinical concern.
- Retrospective data suggest a link between SH and increased cardiovascular events and mortality.
Purpose of the Study:
- To review the current literature on subclinical hypercortisolism in adrenal incidentalomas.
- To highlight diagnostic recommendations and therapeutic considerations.
- To identify gaps in knowledge and suggest future research directions.
Main Methods:
- Literature review of studies published over the last 20 years.
- Analysis of retrospective data on cardiovascular outcomes and mortality.
- Evaluation of current diagnostic guidelines, including the overnight low-dose dexamethasone suppression test.
Main Results:
- Accumulated evidence indicates a higher incidence of cardiovascular events and mortality in patients with SH and adrenal incidentalomas.
- Incomplete suppression on hormonal testing necessitates further investigation and close patient monitoring.
- Unilateral adrenalectomy shows potential benefit for select patients with abnormal suppression and related comorbidities.
Conclusions:
- Subclinical hypercortisolism in adrenal incidentalomas is associated with significant health risks, particularly cardiovascular.
- Current recommendations emphasize screening, risk factor evaluation, and tailored monitoring.
- Prospective studies are crucial for refining risk stratification and optimizing treatment strategies for these patients.
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