Surgery of Subclinical Cortisol Secreting Adrenal Incidentalomas

Inclusion Criteria: * Age ≤ 80 years. * Unilateral SCSI: * Incidentally discovered adrenal tumor with attenuation \< 20 UH and/or relative wash-out (\> 40%) or absolute wash-out (\> 60%) of contrast media and size ≥ 2 cm. Tumors that do not fulfil these criteria might be included if their size is ≤ 4 cm, do not exhibit signs of malignancy (necrosis areas, large and irregular rims) and are stable in size after ≥ 6 months of follow-up. * Impaired 1 mg dexamethasone suppression (Cortisol \> 138 nmol/L or 5 µg/dL), OR Impaired 1 mg dexamethasone suppression (Cortisol \> 50 nmol/L or 1.8 µg/dL) AND one biochemical abnormalities among: * 08h00 plasma ACTH \< 2.2 pmol/L or plasma ACTH following CRH injection ≤ 6.6 pmol/L, * midnight plasma cortisol \> 150 nmol/L, * increased late evening salivary cortisol, * UFC between 1 and 2.0 x N. * Treated BP (and confirmed using an automated home BP monitoring) OR increased BP (≥ 135/85 mmHg) none treated, using an automated home BP monitoring. Exclusion Criteria: * Age \> 80 y, * Bilateral SCSI, Warning: Contralateral nodular formations \< 10 mm are considered as negligible, * Incidentally discovered adrenal tumor size \< 2 cm, * Malignant hypertension, stroke, pulmonary oedema or myocardial infarction during the previous year, * Malignant hypertension during the Run-in period, * Obligatory beta blocker treatment. Patients receiving betablocker treatment for other purpose than hypertension can be included. However, …