Current challenges in laboratory diagnostics of autonomous cortisol secretion in adrenal incidentalomas

Diagnosis of autonomous cortisol secretion

  • Tamara Antonić University of Belgrade – Faculty of Pharmacy, Department of Medical Biochemistry
  • Ana Petrović Mucok University Clinical Center of Serbia, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Department of Endocrinological Laboratory Diagnosis
  • Aleksandra Stefanović University of Belgrade – Faculty of Pharmacy, Department of Medical Biochemistry
Keywords: adrenal incidentalomas, cortisol, low-dose dexamethasone suppression test


Adrenal incidentalomas are unexpectedly identified adrenal masses without prior suspicion of the existence of adrenal disease. The majority of adrenal incidentalomas are benign adrenal adenomas (80–90%), and they are non-functioning adrenocortical adenomas in more than 70% of cases. Mild hypercortisolemia is the most common finding in hormonally active adrenal incidentalomas. It is defined as autonomous cortisol secretion in up to 15% of patients. Despite a lot of research that anticipated higher cardiometabolic risk in patients with autonomous cortisol secretion, there is still no clear consensus on biochemical criteria for an autonomous cortisol secretion diagnosis in patients with adrenal incidentalomas. This review delineates the advantages and limitations of different laboratory tests recommended for the diagnosis of autonomous cortisol secretion in adrenal incidentalomas.


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