Mild autonomous cortisol secretion from a diabetologist's point of view

Czech version

Authors: Jozef Lacka ¹; Barbora Lacková ²
Authors‘ workplace: JAL, s. r. o., Trnava ¹; Interní oddělení, ambulance obezitologie, Nemocnice Rudolfa a Stefanie Benešov, a. s., nemocnice Středočeského, kraje ²
Published in: Diab Obez 2025; 25(1): 37-41
Category: Reviews

Overview

Mild autonomous cortisol secretion (MACS) has a wide range of biological, metabolic, and psychological consequences. Cortisol increases blood glucose levels by promoting gluconeogenesis and enhancing insulin resistance while also affecting bone metabolism. MACS significantly impacts glucose profiles and markedly increases the incidence of diabetes mellitus. For patients with diabetes mellitus and those with uncontrolled hypertension, it is essential to check their medical history for previous CT scans that might have visualized the adrenal glands. In cases where hypercortisolism is suspected, further diagnostic evaluation is required. In our pilot study, we found that half of the patients with type 2 diabetes mellitus (T2DM) had nonsuppressible cortisol levels after a 1 mg DST (Dexamethasone Suppression Test). Patients with a nonsuppressible 1 mg DST showed poorer metabolic compensation compared to those with a suppressible test, although they could still have an HbA_1c ≤ 7 % (DCCT standard). MACS is associated with increased all-cause mortality, particularly in women younger than 65 years. Cardiometabolic comorbidities were significantly less common in patients with nonfunctioning adenomas compared to those with MACS.

Keywords:

diabetes mellitus – mild autonomous cortisol secretion (MACS)

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