Subclinical Cushing's syndrome due to unilateral or bilateral adrenal incidentalomas. Problems of diagnostic and indication to surgical treatment. Review of literature

Abstract

Today subclinical Cushing's syndrome is the most widespread variant of hormonal activity of incidentaloma's hormonal activity. This pathology is defined as a mild intensity autonomous cortisol hypersecretion, not causing specific clinical signs of hypercorticism, but detectable biochemically as derangements of the hypothalamic-pituitary-adrenal axis function. Some clinical symptomatology of metabolic syndrome, such as obesity, impaired carbohydrate metabolism and hypertension, are peculiar to subclinical hypercorticism more than to population. As a result all these symptomatology could lead to increasing cardiovascular risk. Till now there isn't a definite opinion about the need of surgical treatment of present pathology. But there is evidence, that after removing of incidentalomas clinical symptomatology of metabolic syndrome are improving. For understanding all possible risks, connected with subclinical hypercorticism, it's necessary to study the origins of their arising and present about the most adequate screening tests.