Introduction: The management of patients with adrenal incidentaloma (AI) and possible subclinical hypercortisolism (SH) is debated. This randomized study was aimed to evaluate the effects of adrenalectomy on arterial hypertension (AH).
Methods: We consecutively evaluated 590 AI patients (referred to 3 Italian Centres between 06/2016 and 12/2019). Among these, 134 patients showed a possible SH (i.e. 1 mg DST between 1.8 and 5 µg/dl). Based on the exclusion criteria we enrolled 56 SH patients (42 F). Patients were randomized in two groups: surgery (Group 1, n = 23) or conservative follow up (Group 2, n = 30) (3 patients withdrew their consent). Presence of AH was evaluated at baseline and at 6–12 months in the two groups.
Results: So far, 23 patients (9 in Group 1 and 14 in Group 2, mean age 65.1 ± 8.2 years, adenoma diameter 3.0 ± 0.65 cm, 1 mgDST 3.0 ± 2.1 µg/dl) have completed the 6 months follow up. At baseline, the main clinical and biochemical characteristics of the two groups were comparable. In particular, 4/9 patients from Group 1 and 11/14 from Group 2 were hypertensive.
After 6 months, in Group 1 AH improved in all 4 hypertensive patients (1 patient stopped therapy, 2 patients passed from a grade 1 AH to an high-normal blood pressure −BP- without therapy changing, and 1 patient maintained adequate BP despite reducing therapy dose). All non-hypertensive patients (n = 5) presented steady BP. In Group 2, 4 patients (28%) worsened the BP control (2 hypertensive patients worsened AH grade and 2 not hypertensive patients at baseline became hypertensive). However, 2 patients (14%) passed from a grade 1 AH to a high-normal BP without therapy modifications. The remaining8 patients maintained a stable BP control.
Currently,15 patients (5 in Group 1 and 10 in Group 2) have completed the 12 months follow up. The patient from Group 1, who improved AH at 6 months, maintained stable BP levels, while among the remaining patients, including the other hypertensive one, BP remained unchanged vs baseline. Among patients from Group 2, 2 hypertensive patients (20%) worsened BP control, 1 patient (10%) ameliorated the BP control thanks to the increase of the AH therapy, whereas the other 5 hypertensive and the 2 non-hypertensive patients remained stable.
Conclusion: These preliminary data suggest that adrenalectomy has a beneficial role on hypertension in SH patients.
Funding: Supported By Italian Ministry of Health. RF-2013-02356606 Grant.
05 Sep 2020 - 09 Sep 2020