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Exp Clin Endocrinol Diabetes 2019; 127(02/03): 178-184
DOI: 10.1055/a-0713-0598
Review
© Georg Thieme Verlag KG Stuttgart · New York

Adrenal Incidentaloma: Picking out the High-Risk Patients

Guido Di Dalmazi
1   Division of Endocrinology – Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna , Italy
› Author Affiliations
Further Information

Publication History

received 06 June 2018
revised 02 August 2018

accepted 22 August 2018

Publication Date:
29 October 2018 (online)

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Abstract

Patients with adrenal incidentalomas and autonomous cortisol secretion (ACS) have been recognized as a category at risk of developing cardiovascular and metabolic co-morbidities. Considering the increasing number of patients affected by this condition, it is important to perform an accurate subtyping of the patients, in the light of a tailored treatment. This review aims to identify the phenotypic characteristics of patients with adrenal incidentalomas and ACS who are at risk of developing severe cortisol-related co-morbidities. ACS has been associated with severe alteration of the cardiovascular profile, including hypertension, diabetes, and atherosclerosis. Moreover, ACS has been identified as a contributing factor to the development of cardiovascular events and related mortality. Patients with ACS are also at risk of incident bone fractures, which occur in half of the patients independently of the bone mass density, and infectious diseases. Severity and persistence of hypercortisolism are among the main contributing factors for cardiovascular diseases and bone fractures. Moreover, progression of hypercortisolism over time and altered circadian cortisol rhythm seem to be important additional factors. The role of potential novel biomarkers is also discussed in this review.

Key words

adrenal incidentalomas - non-functioning - subclinical hypercortisolism - autonomous cortisol secretion - fractures - osteoporosis - cardiovascular diseases
 

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