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Six controversial issues on subclinical Cushing’s syndrome

Endocrine volume 56, pages 262–266 (2017)Cite this article

Abstract

Subclinical Cushing’s syndrome is a condition of hypercortisolism in the absence of signs specific of overt cortisol excess, and it is associated with an increased risk of diabetes, hypertension, fragility fractures, cardiovascular events and mortality. The subclinical Cushing’s syndrome is not rare, being estimated to be between 0.2–2 % in the adult population. Despite the huge number of studies that have been published in the recent years, several issues remain controversial for the subclinical Cushing’s syndrome screening, diagnosis and treatment. The Altogether to Beat Cushing’s syndrome Group was founded in 2012 for bringing together the leading Italian experts in the hypercortisolism-related diseases. This document represents the Altogether to Beat Cushing’s syndrome viewpoint regarding the following controversial issues on Subclinical Cushing’s syndrome (SCS): (1) Who has to be screened for subclinical Cushing’s syndrome? (2) How to screen the populations at risk? (3) How to diagnose subclinical Cushing’s syndrome in patients with an adrenal incidentaloma? (4) Which consequence of subclinical Cushing’s syndrome has to be searched for? (5) How to address the therapy of choice in AI patients with subclinical Cushing’s syndrome? (6) How to follow-up adrenal incidentaloma patients with subclinical Cushing’s syndrome surgically or conservatively treated? Notwithstanding the fact that most studies that faced these points may have several biases (e.g., retrospective design, small sample size, different criteria for the subclinical Cushing’s syndrome diagnosis), we believe that the literature evidence is sufficient to affirm that the subclinical Cushing’s syndrome condition is not harmless and that the currently available diagnostic tools are reliable for identifying the majority of individuals with subclinical Cushing’s syndrome.

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Authors and Affiliations

  1. Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy

    Iacopo Chiodini & Valentina Morelli

  2. Department of Clinical and Experimental Medicine, Endocrinology Unit, University of Messina, Messina, Italy

    Adriana Albani

  3. Neuroendocrinology Research Laboratory, Istituto Auxologico Italiano, Milan, Italy

    Alberto Giacinto Ambrogio

  4. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Alberto Giacinto Ambrogio & Valentina Morelli

  5. Dipartimento di Medicina Specialistica, UO Endocrinologia Universitaria, Ospedali Riuniti, Foggia, Italy

    Michela Campo

  6. Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy

    Maria Cristina De Martino, Annamaria Colao & Rosario Pivonello

  7. Division of Endocrinology, Polytechnic University of Marche, Ancona, Italy

    Giorgia Marcelli

  8. S.C. di Endocrinologia, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Benedetta Zampetti

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  1. Iacopo Chiodini
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  2. Adriana Albani
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  9. Annamaria Colao
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  10. Rosario Pivonello
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Correspondence to Iacopo Chiodini.

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Chiodini, I., Albani, A., Ambrogio, A.G. et al. Six controversial issues on subclinical Cushing’s syndrome. Endocrine 56, 262–266 (2017). https://doi.org/10.1007/s12020-016-1017-3

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Keywords

  • Subclinical hypercortisolism
  • Adrenal incidentalomas
  • Hypertension
  • Diabetes
  • Osteoporosis