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Some adrenal incidentalomas produce excess cortisol without generating overt features of Cushing syndrome. This syndrome, termed mild autonomous cortisol secretion (MACS), is associated with hypertension, obesity, and excess cardiovascular risk (NEJM JW Gen Med Dec 1 2024 and Eur J Endocrinol 2024; 191:473); however, evidence on the benefits of surgical management is limited.
In this multicenter study, European investigators randomized ≈50 patients (median age, 63) with MACS, hypertension, and unilateral adenoma (≥2 cm) to adrenalectomy or conservative management. Patients with primary aldosteronism were excluded. Results after 1 year of follow-up were as follows:
Patients in the adrenalectomy group required less antihypertensive medications …