Department of Medical Sciences, University of Milan, Endocrinology and Diabetology Unit, Fondazione Ospedale Maggiore Policlinico, Istituto di Ricovero e Cura a Carattere Scientifico, Pad. Granelli, Via F. Sforza 35, 20122 Milan, Italy.
J Clin Endocrinol Metab. 2011 May;96(5):1223-36. doi: 10.1210/jc.2010-2722. Epub 2011 Mar 2.
Subclinical hypercortisolism (SH) is a condition of biochemical cortisol excess without the classical signs or symptoms of overt hypercortisolism. It is thought to be present in the 5-30% of patients with incidentally discovered adrenal mass (adrenal incidentalomas), which in turn are found in 4-7% of the adult population. Therefore, SH has been suggested to be present in 0.2-2.0% of the adult population. Some studies suggested that this condition is present in 1-10% of patients with diabetes or established osteoporosis. The present manuscript reviews the literature on diagnostic procedures and the metabolic effect of the recovery from SH.
A PubMed search was used to identify the available studies. The most relevant studies from 1992 to November 2010 have been included in the review.
The available data suggest that SH may be associated with chronic complications, such as hypertension, diabetes mellitus, overweight/obesity, and osteoporosis. The available intervention studies suggest that the recovery from SH may lead to the improvement of hypertension and diabetes mellitus. A retrospective study suggests that this beneficial effect could be predicted before surgery.
SH is suggested to be associated with some chronic complications of overt cortisol excess. Recovery from this condition seems to improve these complications. However, a large, prospective, randomized study is needed to confirm this hypothesis and to establish the best diagnostic approach to identify patients with adrenal incidentalomas who can benefit from surgery.
亚临床皮质醇增多症（SH）是一种生化皮质醇过多而无显性皮质醇增多症的典型体征或症状的情况。据认为，在偶然发现肾上腺肿块（肾上腺意外瘤）的患者中，有 5-30%存在这种情况，而反过来，在成年人群中，有 4-7%存在肾上腺意外瘤。因此，据推测，SH 存在于 0.2-2.0%的成年人群中。一些研究表明，这种情况存在于 1-10%的糖尿病或已确诊骨质疏松症患者中。本文综述了关于诊断程序和 SH 恢复的代谢影响的文献。
使用 PubMed 搜索来确定可用的研究。从 1992 年到 2010 年 11 月，纳入了最相关的研究进行综述。
现有数据表明，SH 可能与慢性并发症有关，如高血压、糖尿病、超重/肥胖和骨质疏松症。现有的干预研究表明，SH 的恢复可能导致高血压和糖尿病的改善。一项回顾性研究表明，这种有益的效果可以在手术前预测。
SH 与显性皮质醇过多的一些慢性并发症有关。从这种情况中恢复似乎可以改善这些并发症。然而，需要一项大型、前瞻性、随机研究来证实这一假设，并确定最佳的诊断方法，以确定可以从手术中受益的肾上腺意外瘤患者。
