Información del artículo
La aplicación de técnicas de imagen de alta definición como la tomografía axial computarizada o la resonancia magnética ha hecho posible que la identificación de masas adrenales incidentales sea cada vez más frecuente. El estudio funcional de los incidentalomas adrenales permite comprobar que un porcentaje significativo de ellos se comporta de forma autónoma en lo que respecta a la secreción de cortisol, que se muestra independiente del control de las concentraciones de corticotropina. La aplicación de diferentes protocolos diagnósticos está permitiendo caracterizar mejor los incidentalomas adrenales desde el punto de vista funcional, lo que favorece la tipificación de situaciones de autonomía adrenocortical o síndrome de Cushing subclínico. Aun cuando son necesarios más estudios para establecer el impacto del hipercortisolismo subclínico sobre la esperanza de vida, existen evidencias de que se asocia con factores de riesgo cardiovascular y con el desarrollo de osteoporosis, lo que recalca la importancia de su detección, valoración y tratamiento. El desarrollo de la vía laparoscópica en el abordaje quirúrgico de las masas adrenales ofrece una opción terapéutica factible para el tratamiento de las masas adrenales hiperfuncionantes. Establecer qué casos de síndrome de Cushing subclínico son susceptibles de intervención terapéutica es uno de los retos actuales en la patología de la glándula suprarrenal.
Palabras clave:
Incidentaloma adrenal
Cushing subclínico
Autonomía adrenocortical
Masa adrenal
The use of high resolution imaging procedures has increased the identification of incidentally adrenal masses. When properly studied, adrenal incidentalomas show some biochemical features of adrenocortical autonomy in a significant number of cases, setting the basis for the diagnosis of subclinical Cushing syndrome. Recent evidences suggest that subtle glucocorticoid hypersecretion may be associated with metabolic syndrome, high cardiovascular risk and osteoporosis development. In fact, some patients with subclinical hypercortisolism due to adrenal incidentaloma get an improvement of hypertension and metabolic abnormalities following surgical treatment. These data raise several questions related to the need of evaluating and treating subclinical Cushing syndrome, specially when surgery can be performed by the less-aggressive laparoscopic approach. At present, the uniformity of diagnostic criteria, results of spontaneous follow-up and the effects of treatment of subclinical Cushing syndrome represent one of the most interesting challenges in adrenal pathology.
Key words:
Adrenal incidentaloma
Subclinical Cushing
Adrenocortical autonomy
Adrenal mass
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