title: Six controversial issues on subclinical Cushing's syndrome.
abstract: Subclinical Cushing's syndrome is a condition of hypercortisolism in the absence of signs specific of overt cortisol excess, and it is associated with an increased risk of diabetes, hypertension, fragility fractures, cardiovascular events and mortality. The subclinical Cushing's syndrome is not rare, being estimated to be between 0.2-2 % in the adult population. Despite the huge number of studies that have been published in the recent years, several issues remain controversial for the subclinical Cushing's syndrome screening, diagnosis and treatment. The Altogether to Beat Cushing's syndrome Group was founded in 2012 for bringing together the leading Italian experts in the hypercortisolism-related diseases. This document represents the Altogether to Beat Cushing's syndrome viewpoint regarding the following controversial issues on Subclinical Cushing's syndrome (SCS): (1) Who has to be screened for subclinical Cushing's syndrome? (2) How to screen the populations at risk? (3) How to diagnose subclinical Cushing's syndrome in patients with an adrenal incidentaloma? (4) Which consequence of subclinical Cushing's syndrome has to be searched for? (5) How to address the therapy of choice in AI patients with subclinical Cushing's syndrome? (6) How to follow-up adrenal incidentaloma patients with subclinical Cushing's syndrome surgically or conservatively treated? Notwithstanding the fact that most studies that faced these points may have several biases (e.g., retrospective design, small sample size, different criteria for the subclinical Cushing's syndrome diagnosis), we believe that the literature evidence is sufficient to affirm that the subclinical Cushing's syndrome condition is not harmless and that the currently available diagnostic tools are reliable for identifying the majority of individuals with subclinical Cushing's syndrome.
authors.affiliation: Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy. iacopo.chiodini@policlinico.mi.it.
authors.forename: Iacopo
authors.identifier: http://orcid.org/0000-0001-7594-3300
authors.initials: I
authors.lastname: Chiodini
authors.affiliation: Department of Clinical and Experimental Medicine, Endocrinology Unit, University of Messina, Messina, Italy.
authors.forename: Adriana
authors.initials: A
authors.lastname: Albani
authors.affiliation: Neuroendocrinology Research Laboratory, Istituto Auxologico Italiano, Milan, Italy.|Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Alberto Giacinto
authors.initials: AG
authors.lastname: Ambrogio
authors.affiliation: Dipartimento di Medicina Specialistica, UO Endocrinologia Universitaria, Ospedali Riuniti, Foggia, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Campo
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: De Martino
authors.affiliation: Division of Endocrinology, Polytechnic University of Marche, Ancona, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Marcelli
authors.affiliation: Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy.|Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Morelli
authors.affiliation: S.C. di Endocrinologia, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Zampetti
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Colao
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Pivonello
mesh_terms: D003480:Cushing Syndrome / Q000175:diagnosis*; D006801:Humans; D033162:Incidental Findings; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Adrenal incidentalomas; Diabetes; Hypertension; Osteoporosis; Subclinical hypercortisolism