Comorbidities in Mild Autonomous Cortisol Secretion – A Clinical Review of Literature

Abstract

Mild autonomous cortisol secretion (mACS) is a state of cortisol excess usually associated with existence of adrenal incidentaloma. Because of the lack of symptoms of the disease, the biochemical evaluation is the most important to determine a diagnosis. However, scientific societies have different diagnostic criteria for mACS, which makes the treatment of this disease and using results of original papers in daily practice more difficult. Chronic hypercortisolemic state, even if mild, may lead to diseases that are mostly connected with overt Cushing’s syndrome. Some of them can cause a higher mortality of patients with mACS and those problems need to be addressed. In this review we describe the comorbidities associated with mACS: cardiovascular disorders, arterial hypertension, diabetes mellitus, insulin resistance, dyslipidemia, obesity, metabolic syndrome, non-alcoholic fatty liver disease, vertebral fractures and osteoporosis. The point of this paper is to characterise them and determine if and how these conditions should be managed. Two databases – PubMed and Web of Science were searched. Even though the evidence are scarce, this is an attempt to lead clinicians through the problems associated with this enigmatic condition.

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“…Cushing’s syndrome (hypercorticism) is characterised with massive cortisol secretion, which may be because h 3β-HSD2 and r 3β-HSD1 in adrenal glands were upregulated 36 , 37 . Cushing’s syndrome is accompanied with obesity, hypertension, osteoporosis, and type II diabetes 38 , 39 and women’s PCOS is also a metabolic disease, which is characterised by excessive androgen secretion (hyperandrogenism), accompanied by insulin resistance, and polycystic ovary due to increased expression of 3β-HSD2 40 . Although trilostane is a moderate 3β-HSD2 inhibitor and was once used to treat Cushing’s syndrome 41 .…”