Adrenal incidentalomas and subclinical Cushing's syndrome: diagnosis and treatment.
Abstract
PURPOSE OF REVIEW: Adrenal incidentaloma has become a frequent clinical dilemma. Even in the absence of specific clinical features of Cushing's syndrome, adrenocortical incidentalomas may display steroid secretory activity at different degrees. The recognition of endocrine and metabolic dysfunctions associated with subclinical hypercortisolism leads to current awareness about its potential consequences. RECENT FINDINGS: Different protocols and threshold values to define normal cortisol secretion and diagnosis of subclinical Cushing's syndrome have been proposed, including recent practice guidelines for the diagnosis of overt Cushing's syndrome. Follow-up studies have provided additional data about the natural course of the disease and related cardiovascular and metabolic consequences. The study of bilateral adrenocorticotropin-independent macronodular adrenocortical hyperplasia in some familial cases offers a new approach to understanding the spectrum of subclinical cortisol hypersecretion. SUMMARY: The prevalence of subclinical hypercortisolism may be higher than previously reported as more sensitive diagnostic criteria are now recommended. The absence of a single gold standard test, the diversity of diagnostic criteria and the requirement of subsequent meticulous biochemical evaluations before a decision for treatment represent a challenge for the clinical management of this condition.
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The use of midnight salivary cortisol for diagnosing subclinical hypercortisolism is still debated.
“The possible use of midnight salivary cortisol (MSaC), which is more feasible and less expensive, is still debated (73,74).”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [74]
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Cell-To-Cell Communication in Bilateral Macronodular Adrenal Hyperplasia Causing Hypercortisolism
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Activity of selected coagulation factors in overt and subclinical hypercortisolism
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Increased expression of CYP17 and CYP11B1 in subclinical Cushing's syndrome due to adrenal adenomas
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Adipokine and cytokine levels in non-functioning adrenal incidentalomas (NFAI)
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ACTH-Independent Macronodular Adrenal Hyperplasia
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Ocena funkcji płytek krwi u pacjentów z endogenną hiperkortyzolemią
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A pheochromocytoma case diagnosed as adrenal incidentaloma
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ACTH-Independent Cushing’s Syndrome: Bilateral Macronodular Hyperplasia
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Molecular Pathogenesis of Primary Adrenal Cushing’s Syndrome
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Evaluation of Functionality and Growth Rates in Adrenal Incidentalomas: Single Center Experience
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- Authors
- Mazzuco, T. L., Bourdeau, I., & Lacroix, A.
- Affiliations
- Centre Hospitalier de l’Université de Montréal (CA)
- Corresponding author
- Lacroix, André
- Venue
- Current Opinion in Endocrinology, Diabetes & Obesity
- Published
- 2009-06
- Volume
- 16
- Issue
- 3
- Pages
- 203-210
- ISSN
- 1752-296X (ISSN-L)
- OpenAlex
- W181147640
- Cited by
- 48
- References
- 74
- Citations by year
- 2022: 1 · 2020: 3 · 2019: 1 · 2018: 2 · 2017: 4 · 2016: 2 · 2015: 5 · 2014: 2 · 2013: 3 · 2012: 10
- FWCI
- 1.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Current Opinion in Endocrinology Diabetes and Obesity (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- Topics
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- adrenal incidentaloma, subclinical Cushing's syndrome, subclinical hypercortisolism, cortisol secretion, diagnostic criteria, cardiovascular consequences, metabolic effects, treatment decision-making
- MeSH terms
- Adrenal Cortex Function Tests, Adrenal Gland Neoplasms, Algorithms, Cushing Syndrome, Humans, Hydrocortisone, Predictive Value of Tests, Severity of Illness Index, Biomarkers, Disease Progression, Incidental Findings
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