Benign adrenal tumor
ICD-10 D35.0 · ICD-11 2F37.Y&XA0NE9

Treatment of Benign Adrenal Tumor with MACS and Hypertension or Type 2 Diabetes

Patients with a unilateral benign adrenal mass who demonstrate mild autonomous cortisol secretion (MACS) — postdexamethasone serum cortisol above 50 nmol/L in the absence of overt Cushing's syndrome signs or symptoms — and who have comorbidities such as hypertension or type 2 diabetes mellitus present a distinct clinical scenario requiring individualized evaluation.

Clinical Scenario
A unilateral adrenal mass with postdexamethasone serum cortisol >50 nmol/L (1.8 µg/dL), in the absence of overt Cushing's syndrome, accompanied by relevant comorbidities — hypertension or type 2 diabetes mellitus — that may be attributable to cortisol. Guidelines classify postdexamethasone cortisol above this threshold as MACS without further stratification by degree of cortisol nonsuppressibility.
Treatment Approach
In appropriately selected patients with MACS, a relevant comorbidity, and a unilateral adrenal mass, a surgical approach may be discussed on an individualized basis. The complete protocol specifies the criteria for patient selection, the preferred surgical technique, and the perioperative management considerations that apply.
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References

DOI: 10.1093/ejendo/lvad066

  • We recommend that in patients without signs and symptoms of overt Cushing's syndrome a postdexamethasone serum cortisol concentration above 50 nmol/L (> 1.8 µg/dL) should be considered as MACS without any further stratification based on the degree of cortisol nonsuppressibility (⊕⊕○○).
  • We recommend discussing the option of surgery with the patient who has MACS in addition to relevant comorbidities and a unilateral adrenal mass (⊕○○○).
  • If surgery is indicated for a benign adrenal mass causing hormone excess (including MACS), we recommend that a minimally invasive approach is used.
  • We recommend perioperative glucocorticoid treatment at surgical stress doses in all patients undergoing surgery and a preoperative morning serum cortisol >50 nmol/L (1.8 µg/dL) after a 1 mg overnight dexamethasone test.
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