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Субклинический синдром Кушинга, обусловленный одно- и двусторонними образованиями надпочечников. Проблемы диагностики и показаний к хирургическому лечению. Обзор литературы

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Субклинический синдром Кушинга, по результатам многих исследований, является одним из самых распространенных вариантов гормональной активности случайно найденной опухоли надпочечников. Данная патология определяется как автономная гиперсекреция кортизола малой интенсивности, которая не приводит к развитию специфических признаков гиперкортицизма, однако биохимическими методами выявляются нарушения в гипоталамо-гипофизарно-надпочечниковой системе. Больным с субклиническим гиперкортицизмом в большей степени, чем общей популяции, свойственны некоторые проявления метаболического синдрома, такие как ожирение, нарушение углеводного обмена, гипертония. Все эти явления в итоге могут привести к повышению рисков сердечно-сосудистых осложнений. До сих пор в мире нет определенного мнения по поводу необходимости оперативного лечения данной патологии, хотя имеются доказательства, что после удаления образования надпочечника появляются улучшения проявлений метаболического синдрома. Для понимания всех возможных рисков, связанных с наличием субклинического гиперкортицизма, необходимо разобрать причины их возникновения, а также предоставить наиболее подходящие скрининговые тесты для выявления гиперсекреции кортизола малой интенсивности.

Ключевые слова:
субклинический синдром Кушинга, инциденталома, автономная гиперсекреция кортизола, метаболический синдром, subclinical Cushing''s syndrome, autonomous Cortisol hypersecretion, incidentalomas, metabolic syndrome

Литература:
1.Nawar R. Adrenal incidentalomas - a continuing management dilemma. // Endocr Relat Cancer. 2005;12(3):585-598. doi: 10.1677/erc.1.00951
2.Kloos R.T., Gross M.D., Francis I.R., et al. Incidentally discovered adrenal masses*. // Endocr Rev. 1995;16(4):460-484. doi: 10.1210/edrv-16-4-460
3.Reincke M. Subclinical Сushing''s syndrome. // Endocrinol Metab Clin North Am. 2000;29(1):43-56. doi: 10.1016/s0889-8529(05)70115-8
4.Nieman L.K. Approach to the patient with an adrenal incidentaloma. // J Clin Endocrinol Metab. 2010;95(9):4106-4113. doi: 10.1210/jc.2010-0457
5.Terzolo M., Pia A., Reimondo G. Subclinical Сushing''s syndrome: Definition and management. // Clin Endocrinol. 2012;76(1):12-18. doi: 10.1111/j.1365-2265.2011.04253.x.
6.Zeiger M.A., Siegelman S.S., Hamrahian A.H. Medical and surgical evaluation and treatment of adrenal incidentalomas. // J Clin Endocrinol Metab. 2011;96(7):2004-2015. doi: 10.1210/jc.2011-0085
7.Reincke M., Nieke J., Krestin G.P., et al. Preclinical Сushing''s syndrome in adrenal ''''incidentalomas'''': Comparison with adrenal Сushing''s syndrome. // J Clin Endocrinol Metab. 1992;75(3):826-832. doi: 10.1210/jcem.75.3.1517373
8.Mantero F., Terzolo M., Arnaldi G., et al. A survey on adrenal incidentaloma in Italy. // J Clin Endocrinol Metab. 2000;85(2): 637-644. doi: 10.1210/jcem.85.2.6372
9.Beierwaltes W.H., Sturman M.F., Ryo U., et al. Imaging functional nodules of the adrenal glands with 131-I-19-iodocholesterol. // J Nucl Med. 1974;15:246-251.
10.Bulow B., Jansson S., Juhlin C., et al. Adrenal incidentaloma -follow-up results from a swedish prospective study. // Eur J Endocrinol. 2006;154(3):419-423. doi: 10.1530/eje.1.02110.
11.Barzon L., Fallo F., Sonino N., et al. Development of overt Cushing''s syndrome in patients with adrenal incidentaloma. // Eur J Endocrinol. 2002;146(1):61-66. doi: 10.1530/eje.0.1460061
12.Mansmann G., Lau J., Balk E., et al. The clinically inapparent adrenal mass: Update in diagnosis and management. // Endocr Rev. 2004;25(2):309-340. doi: 10.1210/er.2002-0031.
13.Cao C., Yang X., Li L., et al. Increased expression of cyp17 and cyp11b1 in subclinical Cushing''s syndrome due to adrenal adenomas. // Int J Urol. 2011;18(10):691-696. doi: 10.1111/j.1442-2042.2011.02836.x
14.Mitsuhiro K., Masashi D., Takashi Y., et al. Epigenetic Controls of CYP11B2 and CYP11B1 Gene in Subclinical Cushing Syndrome Associated with Overproduction of Aldosterone. Endocrine Society''s 96th Annual Meeting and Expo, June 21-24, 2014. Chicago; 2014.
15.Di Dalmazi G., Kisker C., Calebiro D., et al. Novel somatic mutations in the catalytic subunit of the protein kinase as a cause of adrenal Cushing''s syndrome: A european multicentric study. // J Clin Endocrinol Metab. 2014;99(10):E2093-E2100. doi: 10.1210/jc.2014-2152
16.Vassilatou E., Vryonidou A., Michalopoulou S., et al. Hormonal activity of adrenal incidentalomas: Results from a long-term follow-up study. // Clin Endocrinol. 2009;70(5):674-679. doi: 10.1111/j.1365-2265.2008.03492.x
17.Terzolo M., Osella G., Ali A., et al. Subclinical Cushing''s syndrome in adrenal incidentaloma. // Clin Endocrinol. 1998;48(1):89-97. doi: 10.1046/j.1365-2265.1998.00357.x.
18.Terzolo M., Pia A., Alm A., et al. Adrenal incidentaloma: A new cause of the metabolic syndrome? // J Clin Endocrinol Metab. 2002;87(3):998-1003. doi: 10.1210/jcem.87.3.8277
19.Osella G., Terzolo M., Borretta G., et al. Endocrine evaluation of incidentally discovered adrenal masses (incidentalomas). // J Clin Endocrinol Metab. 1994;79(6):1532-1539. doi: 10.1210/jcem.79.6.7989452
20.Leibowitz G., Tsur A., Chayen S.D., et al. Pre-clinical Cushing''s syndrome: An unexpected frequent cause of poor glycaemic control in obese diabetic patients.// Clin Endocrinol. 1996; 44(6):717-722. doi: 10.1046/j.1365-2265.1996.737558.x
21.Chiodini I., Morelli V., Masserini B., et al. Bone mineral density, prevalence of vertebral fractures, and bone quality in patients with adrenal incidentalomas with and without subclinical hypercortisolism: An italian multicenter study. // J Clin Endocrinol Metab. 2009;94(9):3207-3214. doi: 10.1210/jc.2009-0468
22.Bohdanowicz-Pawlak A., Szymczak J., et al. Subclinical Cushing''s syndrome in adrenal incidentalomas--possible metabolic consequences. // Endokrynol Pol. 2013;64(3):186-191.
23.Chiodini I., Morelli V., Salcuni A.S., et al. Beneficial metabolic effects of prompt surgical treatment in patients with an adrenal incidentaloma causing biochemical hypercortisolism. // J Clin Endocrinol Metab. 2010;95(6):2736-2745. doi: 10.1210/jc.2009-2387
24.Toniato A., Merante-Boschin I., Opocher G., et al. Surgical versus conservative management for subclinical Cushing''s syndrome in adrenal incidentalomas: A prospective randomized study. // Ann Surg. 2009;249(3):388-391. doi: 10.1097/SLA.0b013e31819a47d2
25.Emral R., Uysal A.R., Asik M., et al. Prevalence of subclinical Cushing''s syndrome in 70 patients with adrenal incidentaloma: Clinical, biochemical and surgical outcomes. // Endocr J. 2003;50(4):399-408. doi: 10.1507/endocrj.50.399
26.Rossi R., Tauchmanova L., Luciano A., et al. Subclinical Cushing''s syndrome in patients with adrenal incidentaloma: Clinical and biochemical features. // J Clin Endocrinol Metab. 2000;85(4):1440-1448. doi: 10.1210/jcem.85.4.6515
27.Midorikawa S., Sanada H., Hashimoto S., et al. The improvement of insulin resistance in patients with adrenal incidentaloma by surgical resection. // Clin Endocrinol. 2001; 54(6):797-804. doi: 10.1046/j.1365-2265.2001.01274.x
28.Bernini G., Moretti A., Iacconi P., et al. Anthropometric, haemodynamic, humoral and hormonal evaluation in patients with incidental adrenocortical adenomas before and after surgery. // Eur J Endocrinol. 2003;148(2):213-219. doi: 10.1530/eje.0.1480213
29.Karnieli E., Cohen P., Barzilai N., et al. Insulin resistance in Cushing''s syndrome. // Horm Metab Res. 2008;17(10): 518-521. doi: 10.1055/s-2007-1013593
30.Stubbs M., York D.A. Central glucocorticoid regulation of parasympathetic drive to pancreatic -cells in the obese fa/fa rat. // Int J Obes. 1991;15:547-553.
31.Tauchmanovа L., Rossi R., Biondi B., et al. Patients with subclinical Cushing''s syndrome due to adrenal adenoma have increased cardiovascular risk. // J Clin Endocrinol Metab. 2002;87(11):4872-4878. doi: 10.1210/jc.2001-011766
32.Di Dalmazi G., Vicennati V., Rinaldi E., et al. Progressively increased patterns of subclinical cortisol hypersecretion in adrenal incidentalomas differently predict major metabolic and cardiovascular outcomes: A large cross-sectional study. // Eur J Endocrinol. 2012;166(4):669-677. doi: 10.1530/eje-11-1039
33.Liu Y., Mladinov D., Pietrusz J.L., et al. Glucocorticoid response elements and 11-hydroxysteroid dehydrogenases in the regulation of endothelial nitric oxide synthase expression. // Cardio-vasc Res. 2008;81(1):140-147. doi: 10.1093/cvr/cvn231
34.Hamm L.L., Hering-Smith K.S. Pivotal role of the kidney in hypertension. // Am J Med Sci. 2010;340(1):30-32. doi: 10.1097/MAJ.0b013e3181e590f0
35.Rossi G.P., Andreis P.G., Colonna S., et al. Endothelin-1[1-31]: A novel autocrine-paracrine regulator of human adrenal cortex secretion and growth. // J Clin Endocrinol Metab. 2002;87(1): 322-328. doi: 10.1210/jcem.87.1.8134
36.Xiao D., Huang X., Bae S., et al. Cortisol-mediated potentiation of uterine artery contractility: Effect of pregnancy. // Am J Physiol Heart Circ Physiol. 2002;283(1):H238-H246. doi: 10.1152/ajpheart.00842.2001
37.Swiqtkowska-Stodulska R., Kaniuka-Jakubowska S., Wisniewski P., et al. Homocysteine and alpha-1 antitrypsin concentration in patients with subclinical hypercortisolemia. // Adv Med Sci. 2012;57(2):302-307. doi: 10.2478/v10039-012-0032-8.
38.Morelli V., Palmieri S., Salcuni A.S., et al. Bilateral and unilateral adrenal incidentalomas: Biochemical and clinical characteristics. // Eur J Endocrinol. 2012;168(2):235-241. doi: 10.1530/eje-12-0777
39.Morelli V., Eller-Vainicher C., Salcuni A.S., et al. Risk of new vertebral fractures in patients with adrenal incidentaloma with and without subclinical hypercortisolism: A multicenter longitudinal study. // J Bone Miner Res. 2011;26(8):1816-1821. doi: 10.1002/jbmr.398
40.Chiodini I., Torlontano M., Carnevale V., et al. Bone loss rate in adrenal incidentalomas: A longitudinal study. // J Clin Endocrinol Metab. 2001;86(11):5337-5341. doi: 10.1210/jcem.86.11.8022
41.Zografos G., Perysinakis I., Vassilatou E. Subclinical Cushing''s syndrome: Current concepts and trends. // Hormones. 2014;13(3):323-337. doi: 10.14310/horm.2002.1506.
42.Birsen O., Akyuz M., Dural C., et al. A new risk stratification algorithm for the management of patients with adrenal incidentalomas. // Surgery. 2014;156(4):959-966. doi: 10.1016/j.surg.2014.06.042.
43.Low G., Dhliwayo H., Lomas D.J. Adrenal neoplasms. // Clin Radiol. 2012;67(10):988-1000. doi: 10.1016/j.crad.2012.02.005.
44.Lumachi F., Marchesi P., Мiotto D., et al. CT and MR imaging of the adrenal glands in cortisol-secreting tumors. // Anticancer Res. 2011;31:2923-2926.
45.Vassiliadi D.A., Ntali G., Vicha E., et al. High prevalence of subclinical hypercortisolism in patients with bilateral adrenal incidentalomas: A challenge to management. // Clin Endocrinol. 2011;74(4):438-444. doi: 10.1111/j.1365-2265.2010.03963.x.
46.Barzon L., Scaroni C., Sonino N., et al. Incidentally discovered adrenal tumors: Endocrine and scintigraphic correlates. // J Clin Endocrinol Metab. 1998;83(1):55-62. doi: 10.1210/jcem.83.1.4501
47.Tsagarakis S., Kokkoris P., Roboti C., et al. The low-dose dexamethasone suppression test in patients with adrenal incidentalomas: Comparisons with clinically euadrenal subjects and patients with Cushing''s syndrome. // Clin Endocrinol. 1998; 48(5):627-633. doi: 10.1046/j.1365-2265.1998.00464.x
48.Nieman L.K., Biller B.M.K., Findling J.W., et al. The diagnosis of Cushing''s syndrome: An Endocrine Society Clinical Practice Guideline. // J Clin Endocrinol Metab. 2008;93(5):1526-1540. doi: 10.1210/jc.2008-0125
49.Stewart P.M. Is subclinical Cushing''s syndrome an entity or a statistical fallout from diagnostic testing? Consensus surrounding the diagnosis is required before optimal treatment can be defined. J Clin Endocrinol Metab. 2010;95(6):2618-2620. doi: 10.1210/jc.2010-0633
50.Katabami T., Obi R., Shirai N., et al. Discrepancies in results of low- and high-dose dexamethasone suppression tests for diagnosing preclinical Cushing''s syndrome. // Endocr J. 2005;52(4):463-469. doi: 10.1507/endocrj.52.463
51.Kasperlik-Zaluska A.A., Roslonowska E., Slowinska-Srzednicka J., et al. Incidentally discovered adrenal mass (inciden-taloma): Investigation and management of 208 patients. // Clin Endocrinol. 1997;46(1):29-37. doi: 10.1046/j.1365-2265.1997.d01-1751.x
52.Reimondo G., Allasino B., Bovio S., et al. Pros and cons of dexamethasone suppression test for screening of subclinical Cushing''s syndrome in patients with adrenal incidentalomas. // J Endocrinol Invest. 2014;34(1):e1-e5. doi: 10.1007/bf03346701
53.Grumbach M.M. Management of the clinically inapparent adrenal mass (''''incidentaloma''''). // Ann Intern Med. 2003;138(5): 424. doi: 10.7326/0003-4819-138-5-200303040-00013
54.Zeiger M., Thompson G., Duh Q-Y., et al. American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons medical guidelines for the management of adrenal incidentalomas: Executive summary of recommendations. EndocrPract. 2009;15(5):450-453. doi: 10.4158/ep.15.5.450.
55.Ambrosi B., Peverelli S., Passini E., et al. Abnormalities of endocrine function in patients with clinically ''''silent'''' adrenal masses. // Eur J Endocrinol. 1995;132(4):422-428. doi: 10.1530/eje.0.1320422
56.Caplan R.H. Subclinical hormone secretion by incidentally discovered adrenal masses. // Arch Surg. 1994;129(3):291. doi: 10.1001/archsurg.1994.01420270067016
57.Reincke M., Fassnacht M., Vath S., et al. Adrenal incidentalomas: a manifestation of the metabolic syndrome? // Endocr Res. 1996;22:757-761.
58.Terzolo M., Bovio S., Reimondo G., et al. Subclinical Cushing''s syndrome in adrenal incidentalomas. // Endocrinol Metab Clin North Am. 2005;34(2):423-439. doi: 10.1016/j.ecl.2005.01.008
59.Flecchla D., Mazza E., Carllni M., et al. Reduced serum levels of dehydroepiandrosterone sulphate in adrenal incidentalomas: A marker of adrenocortical tumour. // Clin Endocrinol. 1995; 42(2):129-134. doi: 10.1111/j.1365-2265.1995.tb01852.x
60.Masserini B., Morelli V., Bergamaschi S., et al. The limited role of midnight salivary cortisol levels in the diagnosis of subclinical hypercortisolism in patients with adrenal incidentaloma. // Eur J Endocrinol. 2008;160(1):87-92. doi: 10.1530/eje-08-0485
61.Raff H. A physiologic approach to diagnosis of the Cushing''s syndrome. // Ann Intern Med. 2003;138(12):980. doi: 10.7326/0003-4819-138-12-200306170-00010
62.Arnaldi G., Angeli A., Atkinson A.B., et al. Diagnosis and complications of Cushing''s syndrome: A consensus statement. // J Clin Endocrinol Metab. 2003;88(12):5593-5602. doi: 10.1210/jc.2003-030871
63.Kaltsas G., Chrisoulidou A., Piaditis G., et al. Current status and controversies in adrenal incidentalomas. // Trends Endocrinol Metab. 2012;23(12):602-609. doi: 10.1016/j.tem.2012.09.001
64.Tsagarakis S., Vassiliadi D., Thalassinos N. Endogenous subclinical hypercortisolism: Diagnostic uncertainties and clinical implications. // J Endocrinol Invest. 2014;29(5):471-482. doi: 10.1007/bf03344133
65.Elfenbein D.M., Scarborough J.E., Speicher P.J., et al. Comparison of laparoscopic versus open adrenalectomy: Results from american college of surgeons-national surgery quality improvement project. // J Surg Res. 2013;184(1):216-220. doi: 10.1016/j.jss.2013.04.014
66.Tsuiki M., Tanabe A., Takagi S., et al. Cardiovascular risks and their long-term clinical outcome in patients with subclinical Cushing''s syndrome. // Endocr J. 2008;55(4):737-745. doi: 10.1507/endocrj.K07E-177
67.Akaza I., Yoshimoto T., Iwashima F., et al. Clinical outcome of subclinical Cushing''s syndrome after surgical and conservative treatment. // Hypertens Res. 2011;34(10):1111-1115. doi: 10.1038/hr.2011.90
68.Iacobone M., Citton M., Viel G., et al. Adrenalectomy may improve cardiovascular and metabolic impairment and ameliorate quality of life in patients with adrenal incidentalomas and subclinical Cushing''s syndrome. // Surgery. 2012; 152(6):991-997. doi: 10.1016/j.surg.2012.08.054
69.Terzolo M., Stigliano A., Chiodini I., et al. Ame position statement on adrenal incidentaloma. // Eur J Endocrinol. 2011;164(6):851-870. doi: 10.1530/eje-10-1147
70.Perysinakis I., Marakaki C., Avlonitis S., et al. Laparoscopic adrenalectomy in patients with subclinical Cushing''s syndrome. // Surg Endosc. 2013;27(6):2145-2148. doi: 10.1007/s00464-012-2730-5
71.Morelli V., Reimondo G., Giordano R., et al. Long-term follow-up in adrenal incidentalomas: An italian multicenter study. // J Clin Endocrinol Metab. 2014:jc.2013-3527. doi: 10.1210/jc.2013-3527
72.Cawood T.J., Hunt P.J., O''shea D., et al. Recommended evaluation of adrenal incidentalomas is costly, has high false-positive rates and confers a risk of fatal cancer that is similar to the risk of the adrenal lesion becoming malignant; time for a rethink? // Eur J Endocrinol. 2009;161(4):513-527. doi: 10.1530/eje-09-0234
73.Young W.F. The incidentally discovered adrenal mass. // N Engl J Med. 2007;356(6):601-610. doi: 10.1056/NEJMcp065470
74.Bourdeau I. Aberrant membrane hormone receptors in incidentally discovered bilateral macronodular adrenal hyperplasia with subclinical Cushing''s syndrome. // J Clin Endocrinol Metab. 2001;86(11):5534-5540. doi: 10.1210/jc.86.11.5534
75.Reznik Y., Lefebvre H., Rohmer V., et al. Aberrant adrenal sensitivity to multiple ligands in unilateral incidentaloma with subclinical autonomous cortisol hypersecretion: A prospective clinical study. // Clin Endocrinol. 2004;61(3):311-319. doi: 10.1111/j.1365-2265.2004.02048.x
76.Lacroix A., Baldacchino V., Bourdeau I., et al. Cushing''s syndrome variants secondary to aberrant hormone receptors. // Trends Endocrinol Metab. 2004;15(8):375-382. doi: 10.1016/s1043-2760(04)00188-2
77.De Groot J.W.B., Links T.P., Themmen A.P.N., et al. Aberrant expression of multiple hormone receptors in acth-independent macronodular adrenal hyperplasia causing Cushing''s syndrome. // Eur J Endocrinol. 2010;163(2):293-299. doi: 10.1530/eje-10-0058
78.Groussin L., Perlemoine K., Contesse V., et al. The ectopic expression of the gastric inhibitory polypeptide receptor is frequent in adrenocorticotropin-independent bilateral macronodular adrenal hyperplasia, but rare in unilateral tumors. // J Clin Endocrinol Metab. 2002;87(5):1980-1985. doi: 10.1210/jcem.87.5.8458
79.Joubert M., Louiset E., Rego J-L.D., et al. Aberrant adrenal sensitivity to vasopressin in adrenal tumours associated with subclinical or overt autonomous hypercortisolism: Is this explained by an overexpression of vasopressin receptors? // Clin Endocrinol. 2008;68(5):692-699. doi: 10.1111/j.1365-2265.2007.03106.x
80.Lacroix A. Ectopic and abnormal hormone receptors in adrenal a^hing''s syndrome. // Endocr Rev. 2001;22(1):75-110. doi: 10.1210/er.22.1.75
81.Trejter M., Carraro G., Rucinski M., et al. Arginin-vasopressin regulates proliferative activity of the regenerating rat adrenal cortex. // Int JMolMed. 2005. doi: 10.3892/ijmm.15.6.993
82.Kero J., Poutanen M., Zhang F-P., et al. Elevated luteinizing hormone induces expression of its receptor and promotes steroidogenesis in the adrenal cortex. // J Clin Invest. 2000; 105(5):633-641. doi: 10.1172/jci7716
83.Lacroix A., Tremblay J., Rousseau G., et al. Propranolol therapy for ectopic р-adrenergic receptors in adrenal Cushing''s syndrome. // N Engl J Med. 1997;337(20):1429-1434. doi: 10.1056/nejm199711133372004
84.Katz M.S., Kelly T.M., Dax E.M., et al. Ectopic в-adrenergic receptors coupled to adenylate cyclase in human adreno-cortical carcinomas*. // J Clin Endocrinol Metab. 1985;60(5): 900-909. doi: 10.1210/jcem-60-5-900
85.Goyal A., Panchani R., Varma T., et al. Adrenal incidentaloma: A case of pheochromocytoma with subclinical Cushing''s syndrome. Indian // J Endocrinol Metab. 2013;17(7):246. doi: 10.4103/2230-8210.119587
86.Kimura T., Usui T., Inamoto S., et al. Pheochromocytoma with subclinical Cushing''s syndrome caused by corticomedullary mixed tumor of the adrenal gland. // J Clin Endocrinol Metab. 2009;94(3):746-747. doi: 10.1210/jc.2008-2013
87.Mazzuco T.L., Thomas M., Martinie M., et al. Cellular and molecular abnormalities of a macronodular adrenal hyperplasia causing beta-blocker-sensitive Cushing''s syndrome. // Arq Bras EndocrinolMetabol. 2007;51(9):1452-1462. doi: 10.1590/s0004-27302007000900007
88.Lacroix A., Hamet P., Boutin J-M. Leuprolide acetate therapy in luteinizing hormone-dependent Cushing''s syndrome. // N Engl J Med. 1999;341(21):1577-1581. doi: 10.1056/nejm199911183412104.

Subclinical Cushing''s syndrome due to unilateral or bilateral adrenal incidentalomas. Problems of diagnostic and indication to surgical treatment. Review of literature

Today subclinical Cushing''s syndrome is the most widespread variant of hormonal activity of incidentaloma''s hormonal activity. This pathology is defined as a mild intensity autonomous cortisol hypersecretion, not causing specific clinical signs of hypercorticism, but detectable biochemically as derangements of the hypothalamic-pituitary-adrenal axis function. Some clinical symptomatology of metabolic syndrome, such as obesity, impaired carbohydrate metabolism and hypertension, are peculiar to subclinical hypercorticism more than to population. As a result all these symptomatology could lead to increasing cardiovascular risk. Till now there isn''t a definite opinion about the need of surgical treatment of present pathology. But there is evidence, that after removing of incidentalomas clinical symptomatology of metabolic syndrome are improving. For understanding all possible risks, connected with subclinical hypercorticism, it''s necessary to study the origins of their arising and present about the most adequate screening tests

Keywords:
субклинический синдром Кушинга, инциденталома, автономная гиперсекреция кортизола, метаболический синдром, subclinical Cushing''s syndrome, autonomous Cortisol hypersecretion, incidentalomas, metabolic syndrome