Multidisciplinary Team-Based Management and Outcomes of Patients with Mild Autonomous Cortisol Secretion

Objective: Evidence on the superiority of surgery over conservative management in patients with mild autonomous cortisol secretion (MACS) is limited, and individualized decision-making by a multidisciplinary team (MDT) is recommended. The aim was to analyze the factors influencing management decisions and to assess the outcomes of MACS following conservative management and surgery.

Methods: Data on patients with MACS evaluated by an MDT were retrospectively reviewed. Patients managed conservatively or by surgery were compared based on cardiometabolic parameters (body mass index [BMI], HbA1c, lipid profile, use of anti-diabetic and anti-hypertensive medications) and bone mineral density scores. Clinical and laboratory changes during observation and after surgery were analyzed.

Results: Eighty-two patients were included: 62 (mean ± SD 53.9 ± 9.0 years, 80.6% female) were evaluated at MDT councils and 20 were monitored in the ambulatory clinic. Clinical observation was recommended for 17 (27.4%), surgery for 39 (62.9%), and shared decision-making for 6 patients. Patients recommended for surgery had significantly higher BMI and lesion size, and lower adrenocorticotropic hormone (ACTH) levels compared to those in the observation group. HbA1c levels increased in the observation group, while other parameters remained similar over a median of 32 months follow-up. The cardiometabolic parameters and bone mineral density scores showed no significant differences during a median follow-up period of 13.5 months after surgery.

Conclusion: Patients with high BMI, suppressed ACTH, and large adrenal lesions were more frequently recommended for surgery during MDT councils. No significant changes in cardiometabolic parameters were observed in either group, except for an increase in HbA1c under observation. Larger prospective studies are needed to investigate treatment outcomes.

Cite this article as: Hacioglu A, Uzun İ, Agac ZS, et al. Multidisciplinary team-based management and outcomes of patients with mild autonomous cortisol secretion. Endocrinol Res Pract. Published online June 3, 2025. doi 10.5152/erp.2025.24610.