Randomized trial studying metabolic outcomes and quality of life after adrenalectomy versus conservative management for mild autonomous cortisol secretion
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Objective: Evaluate the impact of adrenalectomy on metabolic parameters and quality of life (QoL) in patients with mild autonomous cortisol secretion (MACS).
Method: A multicenter prospective randomized clinical trial compared adrenalectomy with conservative management. Metabolic parameters and QoL were assessed at baseline and after 2 years.
Results: Forty-three MACS patients with a single adrenal adenoma were randomized to either adrenalectomy (n = 21) or conservative management (n = 22). At baseline, 33 patients had hypertension, 13 had type 2 diabetes (T2D), 18 used statins, and nine patients had osteoporosis. After 2 years, normalization of cortisol levels post 1 mg dexamethasone suppression test was achieved in 19/21 adrenalectomy patients compared to 2/22 patients in the conservative group (P < 0.01). All adrenalectomy patients had a significant increase in ACTH and DHEA-S. Office blood pressure and daily defined doses of antihypertensives (DDD) improved in nine of 12 adrenalectomy patients versus four of 15 conservatively treated patients (P = 0.01). Using 24 h blood pressure and DDD, improvement rates were five of 11 in the adrenalectomy group and six of 15 in the conservative group (P = 0.78). Among patients without T2D, the 120 min glucose level during oral glucose tolerance test was lower in the adrenalectomy group (6.2 vs 7.3 mmol/L, P = 0.04),
but within-group changes were not different (P = 0.76). There were no statistically significant differences in QoL
between the two groups.
Conclusion: Adrenalectomy showed trends toward improvement in office blood pressure and glucose metabolism in MACS, suggesting possible reduction in cardiovascular risk and metabolic complications.
Clinical trials number: NCT01246739
Method: A multicenter prospective randomized clinical trial compared adrenalectomy with conservative management. Metabolic parameters and QoL were assessed at baseline and after 2 years.
Results: Forty-three MACS patients with a single adrenal adenoma were randomized to either adrenalectomy (n = 21) or conservative management (n = 22). At baseline, 33 patients had hypertension, 13 had type 2 diabetes (T2D), 18 used statins, and nine patients had osteoporosis. After 2 years, normalization of cortisol levels post 1 mg dexamethasone suppression test was achieved in 19/21 adrenalectomy patients compared to 2/22 patients in the conservative group (P < 0.01). All adrenalectomy patients had a significant increase in ACTH and DHEA-S. Office blood pressure and daily defined doses of antihypertensives (DDD) improved in nine of 12 adrenalectomy patients versus four of 15 conservatively treated patients (P = 0.01). Using 24 h blood pressure and DDD, improvement rates were five of 11 in the adrenalectomy group and six of 15 in the conservative group (P = 0.78). Among patients without T2D, the 120 min glucose level during oral glucose tolerance test was lower in the adrenalectomy group (6.2 vs 7.3 mmol/L, P = 0.04),
but within-group changes were not different (P = 0.76). There were no statistically significant differences in QoL
between the two groups.
Conclusion: Adrenalectomy showed trends toward improvement in office blood pressure and glucose metabolism in MACS, suggesting possible reduction in cardiovascular risk and metabolic complications.
Clinical trials number: NCT01246739
Date Issued
2025-07-01
Date Acceptance
2025-07-02
Citation
Endocrine Connections, 2025, 14 (7)
ISSN
2049-3614
Publisher
Bioscientifica
Journal / Book Title
Endocrine Connections
Volume
14
Issue
7
Copyright Statement
© 2025 the author(s) Published by Bioscientifica Ltd. Open Access. This work is licensed under a Creative Commons
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/40600855
PII: e250361
Subjects
adrenal incidentalomas
adrenalectomy
CLINICAL BENEFITS
Endocrinology & Metabolism
HYPERCORTISOLISM
INCIDENTALOMAS
Life Sciences & Biomedicine
MACS
metabolic consequences
mild autonomous cortisol secretion
MORTALITY
RISK
Science & Technology
SUBCLINICAL CUSHINGS-SYNDROME
UNILATERAL ADRENALECTOMY
Publication Status
Published
Coverage Spatial
England
Article Number
e250361
Date Publish Online
2025-07-02