Bilateral Adrenal Nodules Presenting With Mild Autonomous Cortisol Secretion

Area of Science:

• Endocrinology
• Adrenal Gland Disorders
• Medical Imaging

Background:

• Benign adrenocortical adenomas are common incidental findings on imaging.
• Bilateral adrenal nodules occur in 15-20% of cases, indicating bilateral adenomas or hyperplasia.
• Mild autonomous cortisol secretion (MACS) affects 19-44% of patients with adrenal adenomas.

Purpose of the Study:

• To review the presentation, diagnosis, and management of patients with bilateral adrenal nodules and MACS.
• To highlight the importance of distinguishing unilateral from bilateral MACS.
• To discuss therapeutic implications for patients with bilateral MACS.

Main Methods:

• Review of clinical presentation and diagnostic approaches for bilateral adrenal nodules and MACS.
• Emphasis on imaging phenotype and adrenal vein sampling for differentiating unilateral vs. bilateral MACS.
• Discussion of treatment outcomes following unilateral adrenalectomy in patients with bilateral MACS.

Main Results:

• MACS is linked to significant cardiovascular morbidity, reduced quality of life, frailty, and increased mortality.
• Reversal of MACS through interventions can improve associated health outcomes.
• Unilateral adrenalectomy offers potential for remission or improvement in MACS degree, depending on laterality.

Conclusions:

• Management of bilateral MACS in the context of bilateral adrenal nodules presents therapeutic challenges.
• Accurate diagnosis of MACS laterality is essential for effective treatment strategies.
• Further research into medical therapies for MACS is warranted given the lack of approved treatments.