Cardio-metabolic effects of mild glucocorticoid excess: Implications for management of adrenal incidentaloma

Adrenal adenomas are incidentally identified in up to 5% of computer tomography scans performed for unrelated indications. A proportion of these adrenal adenomas are found to autonomously secrete cortisol based on definitions in current guidelines. Epidemiological studies suggest that chronic exposure to mild glucocorticoid excess from adrenal adenomas are associated with significantly increased cardiometabolic risk. However, current management guidelines adopt a conservative approach as no large prospective randomised 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 adenoma and possible autonomous cortisol secretion. This article is protected by copyright. All rights reserved.