Cardio‐metabolic pathophysiology in mild glucocorticoid excess: Potential implications for management of adrenal incidentaloma. (18th December 2022)

• Record Type: Journal Article
• Authors: Chen, Angela X.; Burt, Morton G.
• Is Part Of: Clinical endocrinology. Volume 98:Number 2(2023)
• Page Start: 153
• Page End: 164
• Publication Date: 2022-12-18
• Subjects: adrenal adenoma -- glucocorticoid -- glucocorticoid deficiency -- inflammatory arthritis; Endocrinology -- Periodicals; 616.4005
• DOI: 10.1111/cen.14850
• Languages: English
• ISSNs: 0300-0664

Abstract

Abstract: Adrenal adenomas are incidentally identified in up to 5% of computer tomography scans performed for unrelated indications. A proportion of these adrenal incidentalomas are found to autonomously secrete cortisol based on definitions in current guidelines. Epidemiological studies suggest that chronic exposure to mild glucocorticoid excess from adrenal incidentalomas is associated with significantly increased cardiometabolic risk. However, current management guidelines adopt a conservative approach as no large prospective randomized studies have demonstrated that these patients benefit from surgery. This narrative review examines the epidemiological and mechanistic studies related to three common clinical settings of mild glucocorticoid excess to gain further insight into the potential benefits of treating patients with adrenal incidentaloma and possible autonomous cortisol secretion.