Is muscle strength an overlooked parameter in patients affected by mild autonomous cortisol secretion (MACS)? A prospective study

Martina Romanisio; Chiara Mele; Sara Sturnia; Carola Ciamparini; Rosa Pitino; Alice Ferrero; Lorenza Scotti; Gianluca Aimaretti; Paolo Marzullo; Flavia Prodam; Marina Caputo

doi:10.1530/endoabs.110.P71

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Endocrine Abstracts (2025) 110 P71 | DOI: 10.1530/endoabs.110.P71

ECEESPE2025 Poster Presentations Adrenal and Cardiovascular Endocrinology (169 abstracts)

Is muscle strength an overlooked parameter in patients affected by mild autonomous cortisol secretion (MACS)? A prospective study

Martina Romanisio ¹ , Chiara Mele ¹ , Sara Sturnia ¹ , Carola Ciamparini ¹ , Rosa Pitino ¹ , Alice Ferrero ¹ , Lorenza Scotti ² , Gianluca Aimaretti ¹ , Paolo Marzullo ¹ , Flavia Prodam ^1,3 & Marina Caputo ^1,3

Author affiliations

¹Endocrinology, Università del Piemonte Orientale, Department of Translational Medicine, Novara, Italy; ²Università del Piemonte Orientale, Department of Translational Medicine, Novara, Italy; ³Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy

JOINT2327

Background: Adrenal incidentalomas are a growing clinical concern due to their increased prevalence in imaging studies. While most are non-secreting adenomas (NFAA), a significant proportion are associated with mild autonomous cortisol secretion (MACS), linked to various comorbidities, including metabolic and musculoskeletal alterations. The specific impact of MACS on skeletal muscle health, body composition, and quality of life (QoL) remains poorly understood.

Objective: To evaluate the effects of mild cortisol excess on skeletal muscle health, body composition, and QoL in patients with adrenal incidentalomas associated with MACS compared to those with NFAA and healthy controls.

Participants and methods: This cross-sectional case–control study enrolled 62 participants: 21 with MACS, 21 with NFAA, and 20 controls. Skeletal muscle strength was assessed using hand-grip strength, sit-to-stand test and the MRC scale. Body composition was analyzed through bioelectrical impedance analysis (BIA), measuring fat free mass (FFM), muscle mass (MM), and fat mass (FM). QoL was evaluated using EQ-5D and SARC-F questionnaires. Statistical comparisons were performed between groups, and correlations with cortisol levels were explored.

Results: Participants were demographically and anthropometrically comparable across groups. Patients with MACS exhibited a higher prevalence of osteopenia and osteoporosis than NFAA and controls (61.9% vs. 28.6% and 25%, respectively; P=0.036). Although no significant differences were observed in FFM, MM, or FM, MACS patients demonstrated lower muscle strength scores on the MRC scale for biceps and quadriceps than controls (P=0.040 and P=0.0397, respectively). Cortisol levels positively correlated with adenoma size (r=0.347, P=0.0243) but not with muscle strength parameters, despite a clear trend towards less suppression of cortisol values. QoL measures revealed trends toward greater functional impairments in MACS patients, though without statistical significance.

Conclusion: Mild cortisol excess in MACS patients is associated with subtle impairments in muscle strength and a higher prevalence of skeletal health issues, highlighting the potential subclinical impacts on musculoskeletal health and QoL. These findings underscore the clinical significance of MACS and highlight the need for multidisciplinary management strategies for the disease.