Prevalence of Mild Autonomous Cortisol Secretion Among Patients With Adrenal Incidentaloma and Its Association With Metabolic Abnormalities: A Hospital-Based, Analytical, Cross-Sectional Study.

Background Mild autonomous cortisol secretion (MACS) is a common hormonal abnormality among patients with adrenal incidentaloma and has been associated with cardiometabolic abnormalities. However, evidence regarding its prevalence and metabolic associations in Pakistani populations remains limited. This study aimed to determine the prevalence of MACS among patients with adrenal incidentaloma and evaluate its association with metabolic abnormalities. Methodology A hospital-based, analytical, cross-sectional study was conducted among 380 adults with adrenal incidentaloma at Jinnah Hospital, Lahore, affiliated with Allama Iqbal Medical College, Pakistan. Participants underwent clinical, anthropometric, biochemical, hormonal, and radiological assessment. MACS was evaluated using the 1-mg overnight dexamethasone suppression test, with assessment of morning adrenocorticotropic hormone (ACTH) and dehydroepiandrosterone sulfate to support ACTH-independent cortisol secretion. Metabolic abnormalities, including obesity, central obesity, hypertension, diabetes mellitus, dyslipidemia, and metabolic syndrome, were assessed. Multivariable logistic regression was performed to evaluate independent associations after adjustment for relevant demographic, lifestyle, clinical, medication-related, and radiological covariates. Results MACS was identified in 95 (25.0%) participants. Compared with patients without MACS, those with MACS had higher frequencies of obesity, central obesity, hypertension, diabetes mellitus, dyslipidemia, and metabolic syndrome, as well as a greater burden of multiple metabolic abnormalities. After multivariable adjustment, MACS was independently associated with obesity (adjusted odds ratio (aOR) = 1.85, 95% confidence interval (CI) = 1.09-3.14; p = 0.022), diabetes mellitus (aOR = 1.68, 95% CI = 1.01-2.80; p = 0.046), metabolic syndrome (aOR = 1.82, 95% CI = 1.11-2.98; p = 0.017), and the presence of ≥2 metabolic abnormalities (aOR = 1.92, 95% CI = 1.17-3.15; p = 0.010). Larger adrenal lesion size was independently associated with MACS (aOR = 1.38 per cm, 95% CI = 1.14-1.67; p = 0.001). Conclusions MACS was present in one-quarter of patients with adrenal incidentaloma and was associated with a greater cardiometabolic burden. These findings highlight the potential importance of assessing cortisol secretion and metabolic risk in patients with adrenal incidentaloma, while prospective multicenter studies are needed to clarify the clinical significance and temporal relationships of these associations.