Evaluation and Treatment of Patients With Hypercortisolism: A Review.

Importance: With the potential for severe adverse effects of hypercortisolism, the need to limit the development and unrecognized persistence of sequelae from cortisol excess is of great importance on individual and population health levels. This review discusses the evaluation and treatment of patients with hypercortisolism. Pathophysiology; pitfalls in the diagnosis of hypercortisolism; and preoperative, perioperative, and postoperative management considerations are discussed. The association of hypercortisolism with population health and the potential role surgeons and surgery can play in the future of patients with hypercortisolism are also discussed. Higher-level considerations are put forth to encourage a long-term view of future work needed to optimally care for these patients. Observations: Although classic signs and symptoms of hypercortisolism are evident in some patients, mild autonomous cortisol secretion is likely more prevalent and more difficult to detect despite having the potential to cause significant adverse effects, such as increased risk of mortality, and overt hypercortisolism. With treatment, some adverse effects of hypercortisolism may resolve, although not in all patients. Thus, the need for early diagnosis and treatment is of great importance. Conclusions and Relevance: More attention in the future on early treatment of hypercortisolism, whether subclinical or overt, and prevention of adverse effects is warranted for the sake of the individual and the population.