Background: Patients with adrenal incidentaloma (AI) and autonomous cortisol secretion (ACS) show a high prevalence of cardiovascular risk factors and an increased prevalence and incidence of cardiovascular events. Furthermore, some recent data suggest that in these patients, the cardiovascular mortality is also increased. Unfortunately, to date, the diagnosis of ACS is still a matter of debate, and, therefore, it is still not possible to reliably predict the effect of the recovery from ACS in the individual patient. As a consequence, addressing the treatment of choice (i.e. surgical or conservative) is still a challenge in many AI patients.
Material and Methods: We performed a systematic search of medical databases (PubMed, Cochrane Register and EMBASE) until January 31th 2019 using the following key-words: subclinical hypercortisolism, cardiovascular risk, cardiovascular mortality, adrenal incidentaloma and autonomous cortisol secretiom.
Results: The available data show that in AI patients with ACS the surgical removal of the adrenal mass causing ACS can lead to the improvement of hypertension and diabetes, but in many patients with possible ACS the effect of surgery is still largely unknown. No data are available on the effect of the recovery from ACS on the cardiovascular events. Finally, recent evidence suggest that cortisol secretion, peripheral activation and sensitivity could be associated with the presence of hypertension, diabetes and fragility fractures. Therefore, the development of safe and well-tolerated drugs aimed to control cortisol secretion and/or peripheral activation and to modulate glucocorticoid sensitivity will be among the goals of the future research.
Conclusions: Randomized studies are needed to investigate the possibility of predicting the usefulness of surgery by using the available indexes of cortisol secretion in the individual AI patient. The different sensitivity to glucocorticoids and cortisol peripheral activation capacity might influence the choice of the treatment in the individual subject.
18 - 21 May 2019
European Society of Endocrinology