Mild autonomous cortisol secretion: impact on bone health and quality of life. A review

Mild autonomous cortisol secretion (MACS) is associated with several cardiometabolic and non-metabolic comorbidities, including osteoporosis, fractures and worse quality of life (QoL).

We performed a comprehensive review of the literature including articles that reported the association between MACS and osteoporosis, fractures and impact on QoL.

In relation to bone health, several studies reported that the risk of fractures in patients with MACS is discordant with the degree of bone mineral density loss measured per dual X-ray absorptiometry (DXA), suggesting that a reduction in bone quality rather than density contributes to the increased fracture risk. Nevertheless, in general a greater prevalence of vertebral fractures has been described in MACS compared with nonfunctioning adrenal incidentalomas (NFAIs) patients. Regarding QoL, due to the higher burden of comorbidities and the adverse symptoms linked to MACS diagnosis, MACS patients are overall frailer and have worse QoL than patients with NFAIs or the general population. Higher levels of disability related to mental health, middle insomnia and perceived stress have also been described in patients with MACS when compared to NFAIs patients.

MACS patients have a higher prevalence of fractures and osteoporosis, as well as a worse QoL compared to NFAIs and the general population. Thus, both bone health and QoL evaluation should be part of the assessment of patients with MACS diagnosis.