Mild autonomous cortisol secretion in patients with aldosterone-producing adenoma and risk for cardiac remodeling and diastolic dysfunction.

This article focuses on the impact of mild autonomous cortisol secretion (MACS) on cardiac remodeling and diastolic dysfunction in patients with primary aldosteronism (PA) caused by aldosterone-producing adenomas (APA). In a prospective study of 483 patients with APA, 21% had concurrent MACS, which was independently associated with increased left ventricular mass index (LVMI) and worse diastolic function (E/e′ ratio). Surgical adrenalectomy significantly improved cardiac structure and function in patients with APA regardless of MACS status, whereas mineralocorticoid receptor antagonist (MRA) therapy improved LVMI only in patients without MACS and did not improve diastolic function in either group. These findings suggest that excess cortisol contributes independently to adverse cardiovascular outcomes in PA and that adrenalectomy may be the preferred treatment to reverse cardiac abnormalities in patients with concurrent MACS.