Relevance and perspective concept of investigation of subclinical Cushing syndrome.

Abstract

Subclinical Cushing’s syndrome is the most widespread variant of hormonal activity among adrenal incidentalomas. The clinical significance of this condition has been confirmed by numerous studies showing “metabolic consequences” of chronic autonomous cortisol hypersecretion. Some clinical symptomatology of metabolic syndrome, such as obesity, impaired carbohydrate metabolism and hypertension, are peculiar to subclinical hypercorticism more than to population. This requires a thorough examination of patients with adrenal incidentalomas for hormonal activity, as well as determining the indications for surgical intervention. In the current era of evidence-based medicine, the overall management of these tumors remains empirical. The pathogenesis of subclinical Cushing’s syndrome remains unclear. Understanding of the mechanisms of chronic autonomous cortisol hypersecretion would enable to identify clinical and genetic heterogeneity of this condition, to determine prognosis and indications for surgery and to develop pharmacological methods of treatment. The purpose of this article is to review the current views on the diagnosis, pathogenesis and treatment of subclinical Cushing’s syndrome, identifying perspective directions of work.