Hidden hypercortisolism: a too frequently neglected clinical condition.

Area of Science:

• Endocrinology
• Internal Medicine

Background:

• Classic Cushing's syndrome (CS) presents with distinct symptoms, but
• hidden hypercortisolism
• (HidHyCo) cases exhibit unusual or masked manifestations.
• HidHyCo prevalence is higher than classic CS and increases risks for fractures, cardiovascular disease, and mortality.

Purpose of the Study:

• To investigate the prevalence of HidHyCo in patients with bone fragility, hypertension, and type 2 diabetes mellitus (DM2).
• To highlight the significance of recognizing atypical presentations of hypercortisolism.

Main Methods:

• A comprehensive review of published literature on unusual hypercortisolism presentations.
• Analysis of studies focusing on HidHyCo prevalence in diabetic, osteoporotic, and hypertensive populations.

Main Results:

• Identified 49 HidHyCo cases where bone fragility, hypertension, and diabetes were primary signs.
• Bone fragility, hypertension, or DM2 were the sole manifestations in 34.7%, 32.7%, and 6.1% of cases, respectively.
• Population studies suggest HidHyCo prevalence of 1-4% in osteoporosis and 3.4-10% in diabetes.

Conclusions:

• Patients with unexplained bone fragility, resistant hypertension, or worsening DM2 should be screened for HidHyCo.
• Utilizing sensitive diagnostic cut-offs is recommended for accurate HidHyCo detection.
• Early screening can mitigate the severe health risks associated with undiagnosed hypercortisolism.