Why should subtle hypercortisolism be diagnosed?
Is there evidence that these biochemical abnormalities significantly affect patient’s health? What has been most studied to date are the metabolic consequences of subtle hypercortisolism. Numerous studies have shown that cortisol increases hepatic gluconeogenesis, opposes the action of insulin resulting in insulin resistance, promotes hypertension and abdominal fat distribution. Altogether these actions result in the full spectrum of metabolic X syndrome in overt Cushing’s and its resultant increase in cardiovascular mortality and morbidity. A number of studies have shown a remarkably high prevalence of obesity, hypertension and impaired glucose metabolism among patients with adrenal incidentalomas. Similar findings were observed in studies dealing more specifically with SCSA. Interestingly, the prevalence of diabetes and hypertension was greater in patients with SCSA than in patients with putatively non-secreting incidentalomas. A study published by Terzolo et al compared non-obese pa
