Subclinical hypercortisolism in adrenal incidentaloma

Purpose of reviewThe article aims to update the reader on current developments in the area of adrenal incidentaloma complicated by subclinical hypercortisolism. We will discuss different diagnostic strategies and complications associated with this disease, and address the conflicting opinions related to the treatment of these patients.Recent findingsDepending on diagnostic criteria used, between 30 and 50% of patients with adrenocortical incidentaloma have biochemical hypercortisolism, but lack classical external features of Cushing's syndrome. The challenge facing the clinician is that in the sixth and seventh decade of life hypertension, diabetes, osteoporosis and obesity are common and establishing whether these are directly related to the low-grade excess cortisol secretion in a given individual is not straightforward. Nevertheless, this subclinical hypercortisolism has been found to be associated with multiple cardiovascular risk factors, an increased predisposition to cardiovascular events and a higher mortality rate. The dilemma is that it is not established whether surgical excision of the adrenal adenoma in a given individual will improve these complications, and data demonstrate that surgical studies are conflicting.SummarySubclinical hypercortisolism is associated with multiple complications and definite guidelines for diagnosis are necessary. Prospective, randomized controlled studies are needed to ascertain whether medical or surgical interventions are justified, and in which patients.