Due to the wide use of modern imaging techniques in clinical practice, the rate of accidental detection of adrenal masses is on the rise and a term “incidentaloma” was coined to name such lesions. Adrenal incidentalomas are found on cross-sectional abdominal imaging in 4-7% of subjects older than 40 years, and up to 10% in elderly patients. At first, it might seem that incidentalomas do not display hormonal activity, however, in some cases, the hormonal overproduction can be mild and provoke a subclinical form of the disease. Subclinical endocrine disorders can be exceptionally difficult to diagnose because of ambiguous hormonal test results and unclear clinical signs and symptoms.
Mild autonomous cortisol secretion (subclinical hypercortisolism) is the most common endocrinopathy resulting from secretory activity of adrenal tumors and can be present in 5-20% of adrenal incidentalomas. According to the definition, mild autonomous cortisol secretion is characterized by an uncontrolled release of glucocorticoids in the absence of the typical cushingoid phenotype with moon face, plethora, buffalo hump, central obesity with muscular atrophy within the limbs, and purple striae. Despite the lack of the classic clinical features, subclinical glucocorticoid excess can take its toll on metabolic, cardiovascular, and bone health.
Subclinical primary aldosteronism gains an ever-growing attention. Primary aldosteronism might appear not only in severely hypertensive patients, but also in mildly hypertensive or even normotensive individuals. Typical features, such as refractory hypertension, hypokalemia, hypernatremia, polydipsia, and polyuria, appear in just 20-40% of patients. The rest of the affected individuals might not display the full clinical picture of primary hyperaldosteronism, making the evaluation challenging. It is crucial to recognize Conn’s disease early in its course as it poses significant cardiovascular threat to the patients. Subjects suffering from hypertension secondary to primary aldosteronism are significantly more at risk of adverse cardiovascular events than their counterparts with essential hypertension and comparable values of blood pressure.
Subclinical pheochromocytoma is yet another emerging clinical entity. Despite the lack of the classic signs and symptoms suggestive for pheochromocytoma, patients can suffer from catecholamine crisis and its complications. Clinically silent pheochromocytomas are usually found accidentally or in the process of routine screening of families with a known history of familial pheochromocytoma. The clinical presentation of familial pheochromocytoma is often vague. One of the notable examples is a variant of pheochromocytoma associated with SDHB mutations: it is not unusual for this tumor to display a subclinical picture and poorer histological differentiation, both of which might carry additional risk of the disease being diagnosed late and in advanced stage.
The aim of this research topic is to present the clinical picture and complications of subclinical adrenal diseases, to summarize the indications for disorder-specific testing, to offer guidance on appropriate diagnostic evaluation, and to provide current opinion on therapeutic strategies.
We welcome manuscripts such as: original research articles, commentary articles, reviews and mini reviews
Due to the wide use of modern imaging techniques in clinical practice, the rate of accidental detection of adrenal masses is on the rise and a term “incidentaloma” was coined to name such lesions. Adrenal incidentalomas are found on cross-sectional abdominal imaging in 4-7% of subjects older than 40 years, and up to 10% in elderly patients. At first, it might seem that incidentalomas do not display hormonal activity, however, in some cases, the hormonal overproduction can be mild and provoke a subclinical form of the disease. Subclinical endocrine disorders can be exceptionally difficult to diagnose because of ambiguous hormonal test results and unclear clinical signs and symptoms.
Mild autonomous cortisol secretion (subclinical hypercortisolism) is the most common endocrinopathy resulting from secretory activity of adrenal tumors and can be present in 5-20% of adrenal incidentalomas. According to the definition, mild autonomous cortisol secretion is characterized by an uncontrolled release of glucocorticoids in the absence of the typical cushingoid phenotype with moon face, plethora, buffalo hump, central obesity with muscular atrophy within the limbs, and purple striae. Despite the lack of the classic clinical features, subclinical glucocorticoid excess can take its toll on metabolic, cardiovascular, and bone health.
Subclinical primary aldosteronism gains an ever-growing attention. Primary aldosteronism might appear not only in severely hypertensive patients, but also in mildly hypertensive or even normotensive individuals. Typical features, such as refractory hypertension, hypokalemia, hypernatremia, polydipsia, and polyuria, appear in just 20-40% of patients. The rest of the affected individuals might not display the full clinical picture of primary hyperaldosteronism, making the evaluation challenging. It is crucial to recognize Conn’s disease early in its course as it poses significant cardiovascular threat to the patients. Subjects suffering from hypertension secondary to primary aldosteronism are significantly more at risk of adverse cardiovascular events than their counterparts with essential hypertension and comparable values of blood pressure.
Subclinical pheochromocytoma is yet another emerging clinical entity. Despite the lack of the classic signs and symptoms suggestive for pheochromocytoma, patients can suffer from catecholamine crisis and its complications. Clinically silent pheochromocytomas are usually found accidentally or in the process of routine screening of families with a known history of familial pheochromocytoma. The clinical presentation of familial pheochromocytoma is often vague. One of the notable examples is a variant of pheochromocytoma associated with SDHB mutations: it is not unusual for this tumor to display a subclinical picture and poorer histological differentiation, both of which might carry additional risk of the disease being diagnosed late and in advanced stage.
The aim of this research topic is to present the clinical picture and complications of subclinical adrenal diseases, to summarize the indications for disorder-specific testing, to offer guidance on appropriate diagnostic evaluation, and to provide current opinion on therapeutic strategies.
We welcome manuscripts such as: original research articles, commentary articles, reviews and mini reviews
