Journal
BEST PRACTICE & RESEARCH CLINICAL ENDOCRINOLOGY & METABOLISM
Volume 35, Issue 1, Pages -Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.beem.2021.101491
Keywords
Cushing syndrome; hypercortisolism; adrenocortical adenoma; adrenal incidentaloma
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Incidentally discovered adrenal masses may have mild autonomous cortisol secretion, leading to increased health risks. Testing for MACS and surgical adrenalectomy when necessary is recommended, while further studies with adequate randomization and follow-up are needed to determine optimal management strategies.
Incidentally discovered adrenal masses are common and mostly benign and non-functioning adenomas. However, evolving evidence suggests that a notable proportion of these adrenal adenomas may demonstrate mild autonomous cortisol secretion (MACS), which has been associated with an increased risk for hypertension, hyperglycemia, obesity, dyslipidemia, vertebral fractures, adverse cardiovascular events, and mortality. Therefore, it is advised that all patients with an incidentally discovered adrenal mass be tested for MACS. When there is convincing evidence for MACS, surgical adrenalectomy has been associated with an improvement in certain metabolic parameters and a reduction in vertebral fractures; however, conclusive evidence demonstrating decreased cardiovascular outcomes or mortality are not yet available. Future studies with adequate randomization and follow-up to assess adverse clinical endpoints are needed to determine the optimal management and follow-up of patients with MACS. (C) 2021 Elsevier Ltd. All rights reserved.
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