Introduction: Subclinical hypercortisolism (SH), a condition of biochemical cortisol excess without the classical signs or symptoms of overt hypercortisolism, is thought to be present in the 530% of patients with incidentally discovered adrenal mass (adrenal incidentalomas). Some evidence suggest that this condition may lead to long-term consequences of cortisol excess, but indication and potential benefits of adrenalectomy in this state are still in doubt. We analyse a series of patients with SH operated in our center to assess its clinical course after surgery.
Methods: Retrospective study in 25 patients (19 women, 6 men) with an average age of 61.4 years (4583) between 2001 and 2015. Indication for surgery was performed if they met at least two of the following criteria: urinary free cortisol levels higher than 100 μg/24 h, serum cortisol levels after a 1-mg overnight dexamethasone suppression test (Nugent) >1.8 μg/dl, ACTH levels lower than 10 pg/ml and low serum DHEAS (for sex and age). Clinical and laboratory characteristics of the pre and postoperative state are collected.
Results: The cause of diagnosis was mainly adrenal incidentaloma (84%). At diagnosis, 76% of patients had hypertension, and 64% GAA or DM. All patients but one had Nugent >1.8 mcg/dl. Adenomas were mostly left (76%), with an average size of 34.8 cm. Of the 21 patients with more than 1 year of postoperative follow-up, 62% experienced improvement in blood pressure values or carbohydrate metabolism. Postoperative replacement therapy with glucocorticoids was required in 60% of patients, with an average duration of 4.6 months (315). No preoperative biochemical, clinical or radiological parameter was associated with postoperative clinical response.
Conclusion: In 60% of our cases adrenal surgery for SH led to a marked improvement in glycemic control and/or hypertension. We found no biochemical parameter for predicting this favorable response.