Impact of mild autonomous cortisol secretion on metabolism & cardiac morphology in adrenal incidentaloma

OBJECTIVES: Mild autonomous cortisol secretion (MACS) leads to the clustered manifestations of hypertension (HT), diabetes, and metabolic syndromes. However, whether the effect of MACS on myocardial remodeling and cardiac function is similar to that of Cushing's syndrome remains unclear. This study aimed to compare the metabolic risks and impact on cardiac structure and function between MACS and Cushing's syndrome. METHODS: This retrospective study evaluated patients with nonfunctioning adrenal tumors (NFAT), MACS, and Cushing's syndrome. Metabolic parameters and cardiac structure/function indices were compared among the groups. RESULTS: Overall, 208 patients with NFAT (n = 20), MACS (n = 108), and Cushing's syndrome (n = 80) were included. HT, diabetes, and metabolic syndrome were significantly more prevalent in the MACS group than in the NFAT group. Compared with the NFAT group, the MACS group showed significantly higher left ventricular mass index (LVMI) (P = 0.011) and rates of pathological LVMI elevation (P = 0.025). LVMI was significantly higher in both the MACS (P = 0.002) and Cushing's groups (P < 0.001) than in the NFAT group. Meanwhile, the metabolic parameters and LVMI were not significantly different between the MACS and Cushing's groups. CONCLUSIONS: Autonomous cortisol secretion (ACS), including MACS, is associated with higher metabolic risk and LVMI than is NFAT. The metabolic risk and LVMI elevation in MACS are comparable to those in Cushing's syndrome. Hence, all patients with ACS require clinical attention, regardless of the clinical manifestations.