Jiménez Cassinello José María, Vega-Beyhart Arturo, Bernarda Iriarte María, Donato Sara, Herrera-Martínez Aura D, Marazuela Mónica, Araujo-Castro Marta
Endocrinology & Nutrition Department. Hospital Universitario Ramón y Cajal, Madrid, Spain.
Endocrinology Department. Hospital Universitario Fundación Valle del Lili, Cali, Colombia.
Endocrine. 2025 Jun;88(3):693-700. doi: 10.1007/s12020-025-04203-0. Epub 2025 Feb 22.
Mild autonomous cortisol secretion (MACS) is associated with several cardiometabolic and non-metabolic comorbidities, including osteoporosis, fractures and worse quality of life (QoL).
We performed a comprehensive review of the literature including articles that reported the association between MACS and osteoporosis, fractures and impact on QoL.
In relation to bone health, several studies reported that the risk of fractures in patients with MACS is discordant with the degree of bone mineral density loss measured per dual X-ray absorptiometry (DXA), suggesting that a reduction in bone quality rather than density contributes to the increased fracture risk. Nevertheless, in general a greater prevalence of vertebral fractures has been described in MACS compared with nonfunctioning adrenal incidentalomas (NFAIs) patients. Regarding QoL, due to the higher burden of comorbidities and the adverse symptoms linked to MACS diagnosis, MACS patients are overall frailer and have worse QoL than patients with NFAIs or the general population. Higher levels of disability related to mental health, middle insomnia and perceived stress have also been described in patients with MACS when compared to NFAIs patients.
MACS patients have a higher prevalence of fractures and osteoporosis, as well as a worse QoL compared to NFAIs and the general population. Thus, both bone health and QoL evaluation should be part of the assessment of patients with MACS diagnosis.
轻度自主性皮质醇分泌（MACS）与多种心血管代谢和非代谢合并症相关，包括骨质疏松症、骨折以及较差的生活质量（QoL）。
我们对文献进行了全面综述，纳入了报道MACS与骨质疏松症、骨折以及对生活质量影响之间关联的文章。
关于骨骼健康，多项研究报告称，MACS患者的骨折风险与通过双能X线吸收法（DXA）测量的骨矿物质密度损失程度不一致，这表明骨质量而非骨密度的降低导致了骨折风险增加。然而，总体而言，与无功能肾上腺偶发瘤（NFAIs）患者相比，MACS患者中椎体骨折的患病率更高。关于生活质量，由于合并症负担较重以及与MACS诊断相关的不良症状，MACS患者总体上比NFAIs患者或普通人群更虚弱，生活质量更差。与NFAIs患者相比，MACS患者在心理健康、中度失眠和感知压力方面的残疾水平也更高。
与NFAIs患者和普通人群相比，MACS患者骨折和骨质疏松症的患病率更高，生活质量更差。因此，骨骼健康和生活质量评估均应成为MACS诊断患者评估的一部分。
