Hipercortisolismo de origen adrenal

Abstract

Hypercortisolism of adrenal origin is a hormonal disorder caused by chronic exposure to excess glucocorticoids due to adrenal overproduction of cortisol. There is a wide spectrum of clinical presentations of hypercortisolism, from apparently subclinical to full-blown cases depending on the duration and intensity of the hypercortisolism. Consequently, the diagnosis can be complex, given that most of the signs and symptoms are nonspecific. The clinical manifestations are related to an unfavorable cardiometabolic profile, which leads to increased morbidity and mortality in these patients. The biochemical diagnosis is based on confirming autonomous glucocorticoid production by demonstrating the absence of physiological cortisol suppression via a dexamethasone suppression test. The adrenocorticotropic hormone (ACTH) concentration is requested in order to establish the etiological diagnosis. Once the biochemical diagnosis is confirmed, the next step is a radiological study, with the first imaging technique being a computed tomography (CT) scan of the adrenal gland without contrast. The most common cause of endogenous ACTH-independent hypercortisolism is a unilateral cortisol-producing adrenal adenoma. Treatment will be individualized according to the cause and degree of hypercortisolism as well as associated comorbidities.