An Overlooked Disease: Minimal Autonomous Cortisol Secretion (MACS). A Narrative Review.

Area of Science:

• Endocrinology
• Internal Medicine

Background:

• Mild Autonomous Cortisol Secretion (MACS) affects 0.2-2% of the population, exceeding Cushing's syndrome prevalence.
• MACS represents a spectrum of cortisol production, often clinically silent.

Purpose of the Study:

• To review the prevalence, screening, diagnostic criteria, comorbidities, and management of MACS.
• To highlight the importance of early detection and treatment of MACS.

Main Methods:

• Narrative review of studies on MACS prevalence, screening, comorbidities, management, and outcomes.
• Utilized the 1 mg Dexamethasone suppression test (DST) as a primary screening tool.

Main Results:

• MACS is associated with adverse cardiometabolic, renal, bone (osteoporosis/osteopenia), immune, and muscular (sarcopenia) health outcomes.
• Surgery is the preferred treatment; medical therapy is an alternative when surgery is not feasible.
• MACS is linked to depression and coagulopathy.

Conclusions:

• MACS is not asymptomatic and requires vigilance.
• Repeated hormonal and functional tests are essential for preventing multiorgan damage.