Adrenal Incidentalomas and Arterial Hypertension

In the last decades, the prevalence of arterial hypertension, a well-established cardiovascular risk factor, in the general population has substantially been increased. The same holds true for "adrenal incidentalomas" (AI), inapparent adrenal masses detected in approximately 5–10% of patients undergoing imaging of the abdomen for non-adrenal-related diseases. Once excluding the possibility of adrenal lesions being malignant, the clinician has to identify the subgroup of AI that exhibit autonomy of cortisol, aldosterone, or catecholamine secretion, states that are all associated with the development of hypertension. As these entities are usually found in the subclinical form, their clinical significance is not precisely known, and the follow-up and proper management of such patients has not been exactly clarified. In this chapter we attempt to delineate the relation between arterial hypertension and subclinical states of hormone overproduction in AI, such as subclinical Cushing's syndrome, autonomous aldosterone secretion, silent pheochromocytomas, and apparently nonfunctioning lesions. The detailed diagnostic and therapeutic algorithms of the separate overt syndromes are presented in the relevant chapters.