Endocrine Abstracts

Introduction: Mild autonomous cortisol secretion (MACS) is a term used to describe biochemical evidence of abnormal cortisol secretion in patients with adrenocortical adenomas (ACA), but without the classical external manifestations of overt Cushing’s syndrome (CS).

Materials and Methods: In this study, we report a case of patient who presents mild autonomous cortisol secretion among incidentally discovered adrenal masses; followed in unit of the endocrinology, diabetology, metabolic diseases and nutrition department of the Mohammed VI University Hospital of Marrakesh.

Case Report: A 68-year-old woman with a history of well-controlled hypertension and diabete presents to our department for etiological assessment of an adrenal incidentaloma\. adrenal scan confirms a diagnosis of an incidental right adrenal nodule measuring 27×26 mm is also identified having an density of 33UH and washout >50%, the patient’s physical examination is unremarkable and she does not have any overt Cushingoid features or midline back pain or paroxysmal attacks. Biochemical investigations revealed a morning cortisol following 1 mg of dexamethasone is 2 µg/dl .A normal serum potassium and methoxylated derivatives in urine are normal. A diagnosis of a mild autonomous cortisol secretion was made and given the relatively mild degree of cortisol excess and well-controlled Comorbidities a conservative management is chosen, she should undergo annual clinical reassessments. If she develops new or worsening cortisol-related comorbidities, she should undergo further biochemical testing and reconsideration of adrenalectomy.

Discussion: Mild autonomous cortisol secretion is a term used to describe biochemical evidence of abnormal cortisol secretion in patients with ACA, but without the classical external manifestations of overt CS, such as central muscle weakness, adipose tissue redistribution, and skin fragility. Various terms have been used to describe MACS, such as “subclinical Cushing’s syndrome” and “subclinical hypercortisolism”; however, the term “subclinical” is inaccurate, as these patients present with higher prevalence of adverse cardiovascular risk factors, such as diabetes mellitus type 2 (DM2), hypertension, dyslipidemia, obesity, increased rates ofcardiovascular disease, metabolic bone disease, and highermortality rates, when compared with patients with nonfunctioning adrenal tumors (NFAT). The management of patients with an incidentally discovered adrenal adenoma who do not have overt Cushing’s syndrome but who have MACS is more controversial as the available studies comparing outcomes of adrenalectomy vs conservative management have been generally small, observational in nature, and heterogeneous.

Conclusion: 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.