Adrenal cushing’s syndrome: Updates on overt and mild hypercortisolism

Abstract

Adrenal hypercortisolism leads to a varied presentation, with the degree of glucocorticoid excess dictating the phenotype of the disease. Adrenal Cushing’s syndrome may range from a mild presentation (exhibiting features of the metabolic syndrome only) to the typically described stigmata of glucocorticoid excess. Mounting evidence suggests that even small degrees of hypercortisolism may lead to increased morbidity and mortality. New data suggests that previously used diagnostic parameters for mild hypercortisolism might be inadequate to fully identify deleterious biochemical cortisol excess. As our understanding of the genetic, epidemiological, and outcome differences between mild and overt disease increases, the implementation of different diagnostic and treatment modalities will help tailor our management of cortisol excess due to adrenal pathology.