Patients with adrenal aldosterone-producing adenomas (APA) face elevated cardiovascular risks, especially with co-secreted cortisol. This study investigated the association between autonomous cortisol secretion (ACS) in APA and muscle health. Data from 228 APA patients (76 with ACS) undergoing adrenalectomy were analyzed. ACS patients showed significantly higher intermuscular adipose tissue (IMAT) area, lower skeletal muscle area (SMA), and density (SMD). Multivariable regression confirmed ACS's association with IMAT and inverse association with SMA and SMD. Post-adrenalectomy, ACS patients showed decreased IMAT and increased SMA, while non-ACS patients showed increased visceral and subcutaneous adipose tissue. Myosteatosis and sarcopenia are linked to ACS in APA, improving after adrenalectomy.
