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Autonomous hypercortisolism: definition and clinical implications.

Giuseppe Reimondo1, Soraya Puglisi2, Anna Pia2

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Subtle autonomous cortisol excess from adrenal adenomas, often found incidentally, increases cardiovascular risk and mortality. The 1-mg overnight dexamethasone suppression test (DST) helps identify patients at risk.

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Area of Science:

  • Endocrinology
  • Radiology
  • Cardiovascular Medicine

Background:

  • Adrenal adenomas are frequently discovered incidentally during imaging studies.
  • Their prevalence increases with age, affecting up to 10% of the elderly population.
  • A significant subset (20-30%) exhibit autonomous cortisol secretion, often subclinically.

Purpose of the Study:

  • To highlight the clinical relevance of incidentally discovered adrenal adenomas.
  • To emphasize the association between autonomous cortisol excess and adverse health outcomes.
  • To underscore the utility of the 1-mg overnight dexamethasone suppression test (DST) in risk stratification.

Main Methods:

  • Review of current practices and prevalence data for adrenal adenomas.
  • Analysis of the clinical consequences of autonomous cortisol secretion.
  • Evaluation of the 1-mg overnight DST for assessing cardiovascular risk.

Main Results:

  • Incidental adrenal adenomas are a growing public health concern due to increased imaging.
  • Subtle hypercortisolism, even without Cushing's phenotype, is linked to hypertension, diabetes, obesity, and osteoporosis.
  • Higher post-DST cortisol levels correlate with poorer cardiovascular risk profiles and increased mortality.

Conclusions:

  • Subtle autonomous cortisol excess from adrenal adenomas significantly contributes to cardiovascular morbidity and mortality.
  • The 1-mg overnight DST is a valuable tool for stratifying cardiovascular risk in patients with adrenal adenomas.
  • Early identification and management of autonomous cortisol secretion are crucial for mitigating long-term health risks.