This protocol addresses patients with bilateral (macronodular) adrenal hyperplasia or bilateral adrenal adenomas who have mild autonomous cortisol secretion but no overt clinical signs of Cushing's syndrome — a scenario where management decisions require a carefully individualized approach.
Bilateral (macronodular) adrenal hyperplasia or bilateral adrenal adenomas with mild autonomous cortisol secretion (MACS), in the absence of overt Cushing's syndrome. The individualized approach must account for age, sex, degree of cortisol autonomy, general condition, comorbidities, and patient preference.
When intervention is warranted, a surgical approach directed at the dominant lesion may be considered — selected through a structured, individualized evaluation. Notably, a specific bilateral surgical strategy is recommended against in patients who lack overt hypercortisolism. The complete protocol defines the full decision framework, including which patients are appropriate candidates and which are not.
Complete individualized algorithm, candidate selection criteria, and evidence grading are available in the full protocol.