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.
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.
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Miller BS, Auchus RJ. Evaluation and Treatment of Patients With Hypercortisolism: A Review. JAMA Surg. Published online October 14, 2020. doi:10.1001/jamasurg.2020.3280
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: