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Exp Clin Endocrinol Diabetes 2024; 132(12): 712-722
DOI: 10.1055/a-2329-5787
Review

Mild Autonomous Cortisol Secretion (MACS) – Related Osteoporosis

Guido Zavatta
1   Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna
2   Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
,
Guido Di Dalmazi
1   Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna
2   Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
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Abstract

Mild autonomous cortisol secretion (MACS) has thus far been associated with several comorbidities, among which osteoporosis and fractures appear to be highly prevalent. Recent guidelines for adrenal incidentalomas have updated the definition of MACS, currently formulated on serum cortisol after a 1-mg dexamethasone test above 1.8 µg/dL or 50 nmol/L. Previous studies on bone health in adrenal incidentalomas had adopted different definitions of MACS, producing heterogeneous results in terms of fracture prevalence. This review aims to summarize the clinical impact of MACS in relation to fractures, bone quantity and quality, by providing a thorough update on MACS-related osteoporosis (MACS-ROP). This area has a large room for research, and management of this comorbidity still needs to be elucidated.

Keywords

adrenal tumors - osteoporosis - MACS - hypercortisolism - mild autonomous cortisol secretion - fractures


Publication History

Received: 13 January 2024
Received: 02 April 2024

Accepted: 17 May 2024

Accepted Manuscript online:
17 May 2024

Article published online:
11 December 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
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