Cardiometabolic risk and therapeutic outcomes in mild autonomous cortisol secretion

PURPOSE OF REVIEW: Adrenal tumors are increasingly detected due to widespread use of cross-sectional imaging, with mild autonomous cortisol secretion (MACS) present in up to 50% of cases. This review summarizes the current evidence linking MACS to cardiometabolic comorbidities and outcomes, and evaluates the impact of adrenalectomy and emerging medical therapies. RECENT FINDINGS: MACS is consistently associated with higher prevalence of hypertension, impaired glucose metabolism, dyslipidemia, obesity, and cardiovascular events compared to nonfunctioning adrenal tumors (NFATs). Several observational studies and randomized controlled trials have shown that adrenalectomy can improve blood pressure and glycemic control, although evidence regarding lipid metabolism and obesity is mixed. Despite growing evidence, gaps remain in predicting which patients will benefit most from surgical or medical therapy. SUMMARY: MACS is clinically relevant entity with substantial cardiometabolic burden. While adrenalectomy may confer benefits in selected patients, individualized risk stratification remains a key challenge. Future research should focus on identifying predictive biomarkers, clarifying therapeutic thresholds and conducting large-scale prospective trials to inform clinical decision-making.