Hipercortisolismo subclínico en hipertensión arterial refractaria

Introduction

Subclinical hypercortisolism is a condition characterized by excess cortisol without the typical clinical manifestations of Cushing's syndrome, and it is a significant secondary cause of resistant hypertension.Objective: To present recent evidence on the pathophysiology, diagnosis, and treatment of subclinical hypercortisolism in patients with refractory hypertension.Method: A literature review that included peer-reviewed articles, clinical practice guidelines and systematic reviews published in the last five years was conducted. The search terms were: subclinical hypercortisolism, mild autonomous cortisol secretion, resistant hypertension, refractory hypertension, and adrenal incidentaloma.Development: Subclinical hypercortisolism is observed in 5–50% of patients with adrenal incidentalomas and is more prevalent in those with resistant hypertension than in the general hypertensive population. Its pathophysiology is multifactorial and involves the activation of mineralocorticoid and glucocorticoid receptors, the renin-angiotensin-aldosterone system, and the sympathetic nervous system. Diagnosis is based primarily on the nocturnal dexamethasone suppression test, supplemented by measurement of plasma ACTH, nocturnal salivary cortisol, and 24-hour urinary free cortisol. Treatment includes adrenalectomy in selected cases and targeted medical therapy.