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, to be included, patients should need at least an extrastep of hypertensive treatment in order to allow the SAHR decrease following randomisation. The dose of betablocker has to stay the same during all the study.
* UFC \> ULN x 2.0 N,
* 8h00 plasma ACTH \> 20 pg/ml (4.4 pmol/L),
* Chronic renal insufficiency (clearance \< 30 mL/min)
* Dissipation of the biological endocrine criteria for SCSI at the end of the Run-In period,
* Intake of exogenous corticoids or drugs that interfere with dexamethasone metabolism,
* Pregnancy,
* Childbearing woman with no contraceptive effective method (HAS criteria - 77),
* Adverse pathological conditions responsible for reduced life expectancy.

Exclusion criteria after the Run-In period:

* Spontaneous resolution of biological features of SCSI
* Hypertension not confirmed with standard blood pressure self-measurement device
* Hypertension not controlled (≥ 135/85 mmHg) at the end of the Run-In period
* Malignant hypertension (\> 175/115 mmHg)
* Patient receiving betablocker and not receiving at least an extrastep of hypertensive treatment of the SAHR