AACE MENA 2025-Mild Autonomous Cortisol Secretion/MACS

Video Transcription

Video Summary

This presentation focuses on Mild Autonomous Cortisol Secretion (MACS), emphasizing it as a circadian cortisol production disorder rather than simple cortisol excess. MACS is common in adrenal incidentalomas, with prevalence ranging from 19% to 44%. Diagnosis primarily relies on the dexamethasone suppression test and assessing ACTH and DHEA sulfate levels, while urine and late-night salivary cortisol are less reliable due to circadian cortisol variation. MACS leads to comorbidities including hypertension, diabetes, cardiovascular events, frailty, and increased mortality, especially in younger women. Management options include adrenalectomy and medical therapy; surgery often improves metabolic outcomes but carries risks like adrenal insufficiency and glucocorticoid withdrawal syndrome, which requires careful monitoring and gradual tapering of steroids. Bilateral MACS requires specialized assessment. The speaker highlights the importance of evaluating biochemical and clinical severity scores to predict outcomes and tailor treatment. Overall, MACS is a significant endocrine disorder with complex diagnosis, systemic effects, and nuanced management strategies.

Keywords

Mild Autonomous Cortisol Secretion

Circadian Cortisol Disorder

Adrenal Incidentalomas

Dexamethasone Suppression Test

Hypertension and Diabetes Comorbidities

Adrenalectomy Management