ArticleClinical endocrinology2026
Efficacy and Tolerability of Metyrapone in Mild Autonomous Cortisol Secretion: Real-World Findings From Clinical Practice.
Article in Clinical endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Medical therapy in mild autonomous cortisol secretion.Journal of the Endocrine Society · 2026Review
- Efficacy and Tolerability of Metyrapone in Mild Autonomous Cortisol Secretion: Real-World Findings From Clinical Practice.Clinical endocrinology · 2026Article
- Metabolic effects of metyrapone treatment in patients with mild autonomous cortisol secretion: a prospective proof-of-concept trial.EClinicalMedicine · 2026Article
- Managing mild autonomous cortisol secretion (MACS): evaluating the role of medical treatment.Frontiers in endocrinology · 2026Article
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Authors and funding
4 authors.
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No grant is acknowledged in the PubMed record.
Abstract
objectiveMild autonomous cortisol secretion (MACS) is associated with increased cardiometabolic risk factors including hypertension, type 2 diabetes and dyslipidaemia. By using evening doses of metyrapone, a short-acting 11-β hydroxylase inhibitor, it has been shown that it is possible to reset the abnormal circadian cortisol rhythm in MACS. This study aimed to evaluate the tolerability and impact of this approach on cardiometabolic outcomes in patients with MACS.
designWe conducted a single-centre retrospective, longitudinal review of patients with MACS who received evening metyrapone (250-500 mg at 6 PM and 250 mg at 10 PM) to evaluate adverse events, tolerability, and cardiometabolic outcomes (systolic and diastolic blood pressure, HbA1c, weight and non-HDL cholesterol) at 6 months, compared to controls. Age and sex-matched controls were identified from patients with adrenal incidentalomas and non-suppressed serum cortisol following 1 mg overnight dexamethasone suppression testing.
resultsFifteen patients and 15 matched controls were identified. Over 6 months there were no adrenal crises. Metyrapone was stopped in 2/15 patients in view of side effects. In the metyrapone group compared to controls, there were significant decreases in systolic blood pressure (-17.7 (SE 5.8) vs. +8.7 (5.7)mmHg, p = 0.008, n = 9) and diastolic blood pressure (-9.9 (4.2) vs. +3.0 (3.6)mmHg, p = 0.024). The differences between groups for HbA1c, weight and non-HDL cholesterol were not statistically significant.
conclusionEvening metyrapone was associated with significant reductions in systolic and diastolic blood pressure in patients with MACS, without causing adrenal insufficiency, indicating its potential safe clinical utility. A well-powered, controlled, prospective study is needed to validate these findings and comprehensively investigate the broader metabolic outcomes.
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