Surgical Considerations in Subclinical Cushing’s Syndrome. When is it Time to Operate?
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Subclinical Cushing’s syndrome (SCS) is a disorder characterized by autonomous cortisol secretion and the presence of an adrenal incidentaloma, in the absence of clinical features of Cushing’s syndrome. SCS is of special interest because it has been associated with several disorders, such as atherosclerosis and arterial hypertension. Despite decades of research, SCS continues to generate controversy regarding its diagnosis and subsequent management. Several issues remain to be resolved. A universal agreement on the hormonal diagnosis of the syndrome remains elusive. Autonomous cortisol secretion has been ill defined and several definitions have been offered. The heterogeneity in diagnostic criteria creates heterogeneity in studies evaluating optimal management. Minimally invasive adrenalectomy has been documented to ameliorate SCS associated disorders in certain patients. Identifying these patients should be the focus of future research on the subject. In this review we summarize current concepts regarding SCS and indications for its surgical management.
KeywordsHypercortisolism subclinical Cushing’s syndrome adrenal surgery
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