It has been more than 70 years since the first adrenal incidentalomas (AI) were described. Most of these tumors are non-secreting, and are found in 47% of adult population. Patients with subclinical hypercortisolism (or autonomous cortisol secretion) (SH) are observed in 129% of patients with AIs. Evidence suggests that this condition may be associated with higher prevalence of diabetes, obesity, hypertension and osteoporosis.
Between 1999 and 2015, 857 patients with AI were evaluated in Department for Obesity, Reproductive and Metabolic Diseases, Clinic for Endocrinology, Clinical Centre of Serbia. Seventy-two patients were diagnosed with SH based on two out of three criteria: 1 mg overnight dexamethasone cortisol >83 nmol/l, low basal ACTH (below 14 ng/l) and lack of diurnal cortisol rhythm (midnight cortisol >150 nmol/l). Fifty-nine women and thirteen men, mean age 58.37±8.25 years and mean BMI 28.91±5.19 kg/m2. Thirty-seven (51.38%) patients had bilateral tumors and thirty-five (48.61%) had unilateral tumors, mean tumor size was 37.91±10.88 mm and mean follow-up was 5.02±2.98 years. At admission fifty-nine patients (81.94%) had hypertension, 20 (27.7%) had glucose intolerance, 18 (25%) had diabetes and 20 (27.75%) had osteoporosis, 14 patients (19.44%) already suffered cardiovascular events (nine had myocardial infarction and one had a stroke). During the follow-up period one patient (1.38%) had a stroke, one (1.38%) developed diabetes, five (6.94%) developed glucose intolerance and one (1.38%) patient decreased bone mineral density to osteoporotic levels. Three patients underwent surgery due to tumor growth. Pathohistology showed cortical adenoma.
During the average follow-up of 5 years of 72 patients with SH and AI, 1.38% have had a new cardiovascular event, but nearly 7% developed glucose intolerance which is important when deciding about the optimal management and follow-up strategies.