Subclinical Cushing's syndrome in adrenal incidentalomas

Subclinical Cushing’s syndrome is the topic of recent interest and controversy since the serendipitous discovery of an adrenal mass has become an increasingly frequent event owing to the routine use of sophisticated radiological techniques. Clinically inapparent adrenal masses are detected inadvertently, in the course of work-up or treatment of unrelated disorders, and are commonly referred to as adrenal incidentalomas (1-3). The term adrenal incidentaloma is an “umbrella” definition encompassing a spectrum of different pathological entities that share the same path of discovery; adrenal adenoma is the most frequent type of incidental mass (1-3). That adrenal incidentaloma and the related condition of subclinical Cushing’s syndrome are receiving broader attention is justified by the fact that adrenal adenoma is one of the most common tumors in humans and its prevalence increases with age. Therefore, appropriate management of adrenal incidentalomas will be a growing public health challenge for our aging society, also because there is currently increased attention toward subclinical diseases (2, 3). Accordingly, the identification of patients with subclinical Cushing’s syndrome may provide an opportunity for early treatment of a notoriously dangerous disease, while recent refinements in the field of minimally invasive surgery have rendered adrenalectomy a more tantalizing and easy-to-perform procedure. The financial aspect of the problem has to be carefully evaluated since the serendipitous detection of an adrenal mass will be ever growing in the future because of further advances in radiological techniques (4, 5).