Expanding the Clinical Profile of Mild Autonomous Cortisol Secretion: New Diagnostic Markers and Emerging Complications
Authors' conclusion
MACS is associated with neuropsychiatric and gonadal dysfunction. A simple and easily applicable biochemical score, together with late-night cortisol, may support diagnosis, particularly when the DST is inconclusive or in hospitalized patients.
Study context
- Population
- Patients with adrenal incidentalomas (AI) evaluated 2005–2025
- Participants
- 171 patients
- Exposure
- Mild autonomous cortisol secretion (MACS) vs non-functioning AI
- MACSn = 70
- Non-functioning AIn = 101reference
- Outcome
- Clinical and biochemical profiles
Main finding
As reported in the abstract
- MACS vs Non-functioning AI: P = 0.037
- MACS vs Non-functioning AI: P = 0.018
- MACS vs Non-functioning AI: P = 0.014
- MACS vs Non-functioning AI: P < 0.001
- MACS vs Non-functioning AI: P = 0.04
- MACS vs Non-functioning AI: P < 0.001
- MACS vs Non-functioning AI: P < 0.001
- MACS vs Non-functioning AI: P < 0.001
Observational data: associations, not effects.
Further findings
Independent predictors of MACS and 2-point diagnostic score
- ACTH <15 pg/mL independently predicted MACS
- P = 0.029
- DHEAS <0.5 μg/mL independently predicted MACS
- P = 0.009
- AUC of predictors
- 0.78
- 2-point score sensitivity
- 89.5%
- 2-point score NPV
- 97.5%
Late-night cortisol ≥5.1 μg/dL for identifying MACS
- AUC
- 0.83
- Correlation with number of MACS-related comorbidities
- P = 0.0178
Original publication
Expanding the Clinical Profile of Mild Autonomous Cortisol Secretion: New Diagnostic Markers and Emerging Complications. Endocr Pract. Published 17 September 2025. doi:10.
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