The effect of adrenalectomy on the patients with Mild Autonomous Cortisol Secretion

Mild Autonomous Cortisol Secretion (MACS) is associated with cardiometabolic comorbidities, but the benefit of adrenalectomy remains controversial.

We retrospectively reviewed patients undergoing adrenalectomy between October 2019 and October 2024. MACS was defined as post-1 mg dexamethasone suppression test cortisol 1.8-5.0 μg/dL without overt Cushing's syndrome. Pre- and postoperative clinical and biochemical outcomes were analyzed.

Thirty-eight patients met inclusion criteria (median age 64 years; 60.5% female). Median post-DST cortisol was 2.9 μg/dL, with a median follow-up of 258 days. Significant postoperative improvements were observed in systolic (p = 0.001) and diastolic (p = 0.004) blood pressure, HbA1c (p = 0.013), and antihypertensive medication burden (p = 0.009). General health status, HbA1c and number of antihypertensive medications improved in 76.3%, 58.4% and 52.8% of the patients, respectively. Clinical outcomes did not differ between patients with cortisol levels <2.5 vs. ≥2.5 μg/dL.

Adrenalectomy in selected MACS patients is associated with improvements in blood pressure, glycemic control, and overall health, independent of preoperative cortisol levels.