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Mild autonomous cortisol secretion: pathophysiology, comorbidities and management approaches
Alessandro Prete1,2, Irina Bancos3,4
1Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
Nature Reviews. Endocrinology
|April 22, 2024
Summary
Mild autonomous cortisol secretion (MACS) from adrenal adenomas is common and linked to health problems. Individualized management is key, but more research is needed on treatment benefits and biomarkers.
Area of Science:
- Endocrinology
- Oncology
- Internal Medicine
Background:
- Adrenocortical adenomas are common incidental findings on imaging (1-7% prevalence).
- These tumors can be non-functioning or associated with autonomous cortisol secretion.
- Mild autonomous cortisol secretion (MACS) is prevalent (20-50% of adenoma patients) and linked to significant morbidity and mortality.
Purpose of the Study:
- To review the diagnosis, management, and clinical challenges of MACS.
- To highlight current gaps in understanding MACS-related health outcomes and treatment efficacy.
Main Methods:
- Literature review and synthesis of current clinical practice guidelines.
- Analysis of diagnostic criteria and management strategies for MACS.
Main Results:
- MACS is associated with cardiovascular issues, frailty, fractures, reduced quality of life, and increased mortality.
- Management is individualized, involving adrenalectomy or conservative care, but identifying optimal candidates for surgery remains challenging.
- Diagnosis and management of bilateral MACS present unique difficulties.
Conclusions:
- There is a need for specific biomarkers to predict MACS-related health outcomes.
- Further clinical trials are required to establish the efficacy and safety of both adrenalectomy and long-term medical therapy for MACS.
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