ECE2021 Audio Eposter Presentations Adrenal and Cardiovascular Endocrinology (80 abstracts)
Effects of adrenalectomy on arterial hypertension, glucose and lipid metabolism in patients with mild autonomous cortisol secretion: preliminary results of a Randomized Clinical Trial
Sofia Frigerio 1 , 2 , Valentina Morelli 1 , Carmen Aresta 3 , Elena Passeri4 , Flavia Pugliese 5 , Sabrina Corbetta 4 , 6 , Alfredo Scillitani 5 , Maura Arosio 1 , 2 & Iacopo Chiodini 7 & 8
1Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Unit of Endocrinology, Milano, Italy; 2University of Milan, Department of Clinical Sciences and Community Health, Italy; 3Istituto Auxologico Italiano, IRCCS, Department of Endocrinology and Metabolism, Milano, Italy; 4IRCCS Istituto Ortopedico Galeazzi, Endocrinology and Diabetology Service, Milano, Italy; 5’Casa Sollievo della Sofferenza’ IRCCS, Unità Operativa di Endocrinologia, San Giovanni Rotondo, Italy; 6University of Milan, Department of Biomedical, Surgical and Dental Sciences, Milano, Italy; 7Istituto Auxologico Italiano, IRCCS, Unit for Bone Metabolism Diseases and Diabetes & Lab of Endocrine and Metabolic Research, Milano, Italy; 8University of Milan, Department of Medical Biotechnology and Translational Medicine, Milano, Italy
Introduction
The management of patients with adrenal incidentaloma (AI) and mild autonomous cortisol secretion (MACS) is debated. This randomized study aimed to evaluate the effects of adrenalectomy on arterial hypertension (AH), glucose and lipid metabolism.
Methods
We consecutively evaluated 626 AI patients (referred to 3 Italian Centers between 06/2016 and 02/2020). According to the inclusion criteria, we enrolled 61 patients (45 F) with MACS (cortisol level after 1mg overnight dexamethasone suppression test, 1 mgDST, between 1.8 and 5 µg/dl). Patients were randomized in surgery (Group 1, n = 29) or conservative follow-up groups (Group 2, n = 32). Three patients from Group 1 withdrew their consent. Blood pressure (BP) and glyco-metabolic parameters were evaluated at baseline and after 6 months. The study is ongoing.
Results
So far, 40 patients (15 in Group 1 and 25 in Group 2, mean age 64.4 ± 10.4 years, adenoma diameter 2.8 ± 0.7 cm, 1 mgDST 3.3 ± 1.6 µg/dl) have completed the 6 months follow-up. At baseline the two groups were comparable for all characteristics. In particular, 8 patients from Group 1 and 16 from Group 2 were hypertensive; 11 from Group 1 and 14 from Group 2 were dyslipidemic; 3 and 6 patients, respectively in Group 1 and in Group 2, were diabetic. After 6 months, in Group 1, 8 patients (57.1%) improved BP (in particular 2 hypertensive patients passed from a grade 1 AH to a high-normal BP and other 2 hypertensive patients passed from a grade 2 to a grade 1 AH), only 2 (14.3%) worsened BP control; in Group 2, BP improved in 5 patients (20%), but worsened in 8 (32%), (P = 0.05). Glycemic control improved in 1 patient of both groups, but worsened in 4 patients of Group 2 and in 1 of Group 1 (16% vs 6.7%); in the subgroup of diabetic patients, only 2 non-operated patients worsened glycemic control at follow-up. Insulin-resistance, evaluated by HOMA-IR, remained steady in Group 1, while it showed a worsening trend in Group 2: 2.7 ± 2.1 at baseline vs. 6.0 ± 10.2 at 6 months (P = 0.07). LDL-cholesterol levels improved in 4 patients of Group 1 (26.7%) and in 2 patients of Group 2 (8.3%); on the other hand, they worsened in 4 patients of Group 1 (26.7%), and in 4 patients Group 2 (16.7%).
Conclusion
These preliminary data suggest that, in MACS-patients, adrenalectomy has a beneficial role on glucose and lipid metabolism, but above all on AH.
Funding
Supported By Italian Ministry of Health. RF-2013-02356606 Grant.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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