The landscape of bilateral adrenal incidentalomas associated with subclinical hypercortisolism

Excerpt

Since the first report of a “subclinical” Cushing’s syndrome dated back to the early 1970s [1], a great deal of effort has been put to understand the molecular pathogenesis and the clinical correlates of this condition. Despite the exponential number of publications over the last years, it is still difficult to draw definitive conclusions on the clinical impact of incidentally diagnosed hypercortisolism, not associated with a clear Cushing’s phenotype. As every physician involved in the management of adrenal diseases knows, the main source of uncertainty resides in the definition of this pathological condition, which generates difficulties in achieving comparable results among different studies, and the lack of well-designed prospective studies covering a long time span, leading to difficulties in estimating the prevalence of cortisol-associated comorbidities and long-term consequences. However, keeping in mind those limitations, evidence from long-term retrospective studies has indirectly shown that a mild, but sustained, cortisol hypersecretion can be related to an increased risk of cardiovascular and metabolic correlates, which seems to be related to the cortisol secretion, as well as to the progressive secreting pattern over time [2‐4]. …