Endocrine Abstracts

JOINT1368

The justification of the elective surgery in a patient with mild autonomous cortisol secretion (MACS) is debatable, as adrenalectomy does not result in clinical improvement in every patient, especially in cases without lateralization of hormone secretion. So why not try to treat these patients pharmacologically, avoiding irreversible surgery? We would like to present the preliminary findings of the study we are conducting in Poland, in the first 9 MACS patients out of 50 planned as per protocol, treated with low-dose metyrapone. 6 patients have completed 6-month treatment, 3 others are so far at 3 months, and 5 more have been enrolled to date. Presented group consists of 8 women and 1 man, mean age 63.44 ± 7.41 years. 5 out of 9 presented bilateral adrenal lesions. Hypertension has been diagnosed in 8 subjects, hyperlipidaemia in all 9, 8 were overweight or obese, 4 had impaired glucose tolerance, and 5 presented osteopenia or osteoporosis. 500 mg of metyrapone (two caps of Metopirone® 250 mg) have been administered once daily at circa 7pm with a light meal. The drug was well tolerated by all patients. The following tests have been performed prior to treatment and at 3 and/or 6 months: - metabolic profile including HbA1C and oral glucose tolerance test (OGTT) measuring both glucose and insulin concentrations in patients without diabetes; morning and midnight serum cortisol, ACTH plasma concentration and 24-h urinary free cortisol (UFC), body composition and bone mineral density assessment. During treatment with metyrapone, we observed a reduction in morning and midnight serum cortisol levels, as well as in 24-h urinary cortisol excretion. No disinhibition of ACTH secretion was noted. After 3 months of treatment already, the effect of metyrapone upon blood pressure made possible in almost half of the patients (4/9) discontinuation of one of the anti-hypertensive drugs they were taking. In patients who completed the full 6-month course of treatment, we found considerable decrease in body weight (2/6), body fat (3/6), waist circumference (6/6), insulin (2/6) and uric acid (5/6) levels. Further patients are being enrolled in the study. The final statistical analysis is planned upon completion of the study on a set of 50 patients. Preliminary observations are encouraging with regard to the anticipated effects of the proposed treatment in MACS patients. As part of this presentation, we prepared a case report on our first MACS patient who completed the study.