{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T11:03:16Z","timestamp":1790420596020,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T00:00:00Z","timestamp":1762387200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T00:00:00Z","timestamp":1762387200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Mild 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\u2010acting 11\u2010\u03b2 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>We conducted a single\u2010centre retrospective, longitudinal review of patients with MACS who received evening metyrapone (250\u2013500\u2009mg at 6 PM and 250\u2009mg at 10 PM) to evaluate adverse events, tolerability, and cardiometabolic outcomes (systolic and diastolic blood pressure, HbA1c, weight and non\u2010HDL cholesterol) at 6 months, compared to controls. Age and sex\u2010matched controls were identified from patients with adrenal incidentalomas and non\u2010suppressed serum cortisol following 1\u2009mg overnight dexamethasone suppression testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifteen 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 (\u221217.7 (SE 5.8) vs. +8.7 (5.7)mmHg,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20099) and diastolic blood pressure (\u22129.9 (4.2) vs. +3.0 (3.6)mmHg,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.024). The differences between groups for HbA1c, weight and non\u2010HDL cholesterol were not statistically significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Evening 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\u2010powered, controlled, prospective study is needed to validate these findings and comprehensively investigate the broader metabolic outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cen.70056","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T03:54:11Z","timestamp":1762487651000},"page":"215-221","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Efficacy and Tolerability of Metyrapone in Mild Autonomous Cortisol Secretion: Real\u2010World Findings From Clinical Practice"],"prefix":"10.1111","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-9100-8778","authenticated-orcid":false,"given":"Simon","family":"Berry","sequence":"first","affiliation":[{"name":"Division of Clinical Medicine University of Sheffield Sheffield UK"},{"name":"Department of Diabetes and Endocrinology Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Division of Clinical Medicine University of Sheffield Sheffield UK"},{"name":"Department of Diabetes and Endocrinology Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Newell\u2010Price","sequence":"additional","affiliation":[{"name":"Division of Clinical Medicine University of Sheffield Sheffield UK"},{"name":"Department of Diabetes and Endocrinology Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Debono","sequence":"additional","affiliation":[{"name":"Division of Clinical Medicine University of Sheffield Sheffield UK"},{"name":"Department of Diabetes and Endocrinology Sheffield Teaching Hospitals NHS Foundation Trust Sheffield 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