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Published on: April 25, 2016
Medical therapy in mild autonomous cortisol secretion.
Alan Kelsall1, Michelle Agboola1, Evie Bryden1
1School of Medicine and Population Health, University of Sheffield, Sheffield S10 2RX, UK.
Journal of the Endocrine Society
|June 4, 2026
Summary
Medical therapy for mild autonomous cortisol secretion (MACS) is under-researched. Limited studies suggest potential benefits of metyrapone or mifepristone for MACS, highlighting the need for larger trials.
Area of Science:
- Endocrinology
- Pharmacology
Background:
- Mild autonomous cortisol secretion (MACS) is increasingly prevalent with age.
- MACS is linked to cardiometabolic issues and higher mortality.
- Current guidelines favor conservative management or surgery; no medications are licensed for MACS.
Purpose of the Study:
- To systematically review evidence on medical therapies for MACS.
- To identify research gaps in MACS treatment.
- To define outcome measures for future clinical trials.
Main Methods:
- Comprehensive literature search of MEDLINE, EMBASE, and trial registries.
- Screening of titles and abstracts, followed by full-text review.
- Inclusion of studies on medical treatments for MACS.
Main Results:
- Thirteen studies (5 full-text, 8 abstracts) met inclusion criteria.
- Metyrapone and mifepristone were studied in 2 and 3 studies, respectively.
- Common outcomes included blood pressure, glucose, weight, and side effects.
Conclusions:
- Significant knowledge gaps exist regarding medical management of MACS.
- Preliminary evidence suggests potential benefits of mifepristone or metyrapone.
- Urgent need for large, prospective studies with defined outcome measures.
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