Adrenal incidentalomas (AI) may be associated with a mild autonomous cortisol secretion (MACS) in up to one third of cases. There is growing evidence that MACS patients actually present increased risk of cardiovascular disease and higher mortality rate, driven by increased prevalence of known cardiovascular risk factors, as well as accelerated cardiovascular remodelling. Adrenalectomy seems to have cardiometabolic beneficial effects in MACS patients but their management is still a debated topic due to the lack of high-quality studies. Several studies suggested that so called “non-functioning” AI may be actually “functioning” with an associated increased cardiovascular risk. Although the individual cortisol sensitivity and peripheral activation have been recently suggested to play a role in influencing the cardiovascular risk even in apparently eucortisolemic patients, to date the degree of cortisol secretion, as mirrored by the cortisol levels after dexamethasone suppression test remains the best predictor of an increased cardiovascular risk in AI patients. However, whether or not the currently used cut-off set at 50 nmol/L for cortisol levels after dexamethasone suppression could be considered completely reliable in ruling out hypercortisolism remains unclear.

在多达三分之一的病例中，肾上腺偶发瘤 (AI) 可能与轻度自主皮质醇分泌 (MACS) 相关。越来越多的证据表明，由于已知心血管风险因素的患病率增加以及心血管重塑加速，MACS 患者实际上呈现出更高的心血管疾病风险和更高的死亡率。肾上腺切除术似乎对 MACS 患者的心脏代谢有益，但由于缺乏高质量的研究，它们的管理仍然是一个有争议的话题。几项研究表明，所谓的“无功能”人工智能可能实际上“有功能”，并增加了心血管风险。尽管最近有人认为个体皮质醇敏感性和外周激活在影响心血管风险中发挥作用，即使在明显的皮质醇过多患者中，迄今为止，地塞米松抑制试验后皮质醇水平反映的皮质醇分泌程度仍然是最佳预测指标AI 患者的心血管风险增加。然而，目前使用的地塞米松抑制后皮质醇水平的临界值设定为 50 nmol/L 是否可以被认为完全可靠地排除皮质醇增多症仍不清楚。