Update on the risks of benign adrenocortical incidentalomas

Purpose of review Recent studies highlighted the association between adrenocortical incidentalomas and several comorbidities. This review summarizes the most recent evidence showing the potential risks related to adrenocortical tumors classified as nonfunctioning adrenal incidentalomas (NFAIs) or associated with clinically autonomous cortisol secretion (ACS). Recent findings Alterations in glucose metabolism are a common finding in patients with ACS (30% of the cases). As shown in nonrandomized trials, surgical treatment may improve or cure diabetes in 52% of patients. Cross-sectional studies showed that NFAIs are also associated with insulin resistance. In a recent long-term retrospective study, patients with NFAI were at increased risk of developing prediabetes/diabetes during follow-up. Similarly, a prospective study showed that the incidence of prediabetes was higher also in tumors converting from NFAI to ACS. Patients with ACS are at increased risk of cardiovascular events and related mortality. Some cardiovascular markers were altered in patients with NFAI, even if a cause-effect relationship is not readily evident. Finally, 13% of NFAIs have increased risk of developing ACS during long-term follow-up. Summary Patients with NFAI are at increased risk of developing alterations of glucose metabolism, whereas those with ACS or NFAI who converted to ACS over time are at risk for cardiovascular diseases.