Beneficial metabolic effects of surgical treatment in patients with an adrenal incidentaloma causing subclinical hypercortisolism
Iacopo Chiodini1, Valentina Morelli1, Antonio Stefano Salcuni1,2, Cristina Eller Vainicher1, Massimo Torlontano2, Francesca Coletti3, Laura Iorio4, Antonello Cuttitta2, Angelo Ambrosio2, Leonardo Vicentini1, Fabio Pellegrini2,5, Massimiliano Copetti2, Paolo Beck-Peccoz1, Maura Arosio1,3, Bruno Ambrosi4, Vincenzo Trischitta2,6 & Alfredo Scillitani2
Objective: In patients with adrenal incidentalomas (AI) the metabolic effect of the recovery of subclinical hypercortisolism (SH) is debated. The aim of this study was to determine the effect of the surgical and conservative approaches on the metabolic syndrome in AI patients with and without SH.
Patients: One hundred and eight AI patients were studied; SH was diagnosed in the presence of >2 out of: urinary free cortisol >70 μg/24 h (193 nmol/24 h), cortisol after 1mg-dexamethasone-suppression-test >3.0 μg/dl (83 nmol/l), ACTH <10 pg/ml (2.2 pmol/l). Surgery was performed in 25 patients with SH (Group TrSH+) and 30 without SH (Group TrSH−), while the conservative approach was chosen by 16 patients with SH (Group UntrSH+) and 37 without SH (Group UntrSH−).
Methods: During the follow-up (1848 months), the improvement/worsening of body weight, blood pressure or glucose and cholesterol levels was defined in the presence of a >5% weight decrease/increase and following the European Society of Cardiology or the ATPIII criteria, respectively.
Results: In Group TrSH+, weight, blood pressure and glucose levels improved (32%, 56%, 48%, respectively) more frequently than in Group UntrSH+(12.5%, P=0.05; 0.0%, P<0.0001; 0.0%, P=0.001; 0.0%, P=0.0014, respectively). In Group UntrSH+, blood pressure, glucose and LDL levels worsened more frequently (50.0%, 37.5%, 50.0%, respectively) than in Group TrSH+(0.0%, P<0.0001; 0.0%, P=0.001, 20.0%, P=0.05, respectively). The surgical treatment was associated with weight loss (OR 6.5, 95% CI 1.236.5, P=0.034), improvement of blood pressure (OR 5.9, 95% CI 1.918.0, P=0.002), and fasting glucose levels (OR 4.4, 95% CI 1.216.9, P=0.031), regardless of age, duration of follow-up, and for the presence of obesity or arterial hypertension or diabetes mellitus at baseline. A treatment-by-SH group interaction was present for fasting glucose (P=0.36) and tended to the statistical significance for blood pressure levels (P=0.073).
Conclusions: Regarding the various components of the metabolic syndrome, in AI patients with SH, surgery is beneficial.