Endocrine Abstracts

The aim of this retrospective study was to compare the long-term evolution of adrenal insufficiency (AI) due to bilateral adrenal surgery (S) or medical cause (M).

Seventy AI patients (mean age 41±16 years; 60% female, similar in both groups) were followed during a mean 6-year period (2–16); 38 were AI after bilateral adrenalectomy (60% Cushing), 32 AI of medical origin (62% polyglandular autoimmune syndrome). BMI, blood pressure (BP), fasting blood glucose (FBG), cholesterol, triglycerides (TG), metabolic therapy, cardiovascular events, AI episodes, hospital admissions, and death were recorded at the beginning of replacement therapy (T1) and at last news (T2).

At T1, prevalences of overweight/obesity, hypertension, type 2 diabetes (T2D and mean TG level were higher in S compared to M group (P<0.01). At T2, the prevalence of overweigh/obesity, hypertension and T2D were similar in both group (20–34%) but TG level remained higher in S group (P=0.01).

Between T1 and T2, 0% S patients developed hypertension and its prevalence decreased significantly (P<0.003) from 58% (T1) to 34% (T2) while other metabolic disorders prevalences remained the same. In M group, 22% developed hypertension, 21% T2D and 21% dyslipidemia while the prevalence of overweight increased significantly (P<0.005). A significantly higher weight gain in M vs. S groups (P=0.0006) and a greater FBG decrease in S vs. M groups (P<0.0001). Eight patients died (1 S). Cardiovascular events were more frequent in S (10%) vs. M (3%) groups. Acute AI (median/patient S: 0 (0–1); M 1 (0–5)) and hospital admissions (S: 1 (0–6); M: 2 (0–5)) did not differ between the 2 groups.

Conclusion: Compared to baseline, bilateral adrenalectomy appeared safe in the long-term and enabled significant improvement of hypertension and other metabolic disorders. Overtime, adrenal insufficiency, whatever surgical or medical origin were complicated with a metabolic syndrome in 20–30% of cases.