ECEESPE2025 Rapid Communications Rapid Communications 1: Adrenal and Cardiovascular Endocrinology (5 abstracts)
Long-term cardiovascular outcomes after adrenalectomy in mild autonomous cortisol secretion: results from the multicentric ENSAT NAPACA outcome study
Guido Di Dalmazi 1 , Massimo Terzolo 2 , Timo Deutschbein 3 , Irina Bancos 4 , Claudio Letizia 5 , Lorenzo Tucci 1 , Soraya Puglisi 2 , Roberta Giordano 6 , Henrik Falhammar 7 , Alessandro Prete 8 , Sabina Zacharieva 9 , Krystallenia Alexandraki 10 , Martin Reincke 11 , Paola Loli 12 , Antonio Stigliano 13 , Filippo Ceccato 14 , Barbara Altieri 15 , Bahaa Salama 4 , Luigi Petramala 5 , Mirko Parasiliti Caprino 6 , C Christofer Juhlin 16 , Elio Ferreira 4 , Francesco Circosta 5 , Alexandro Paccapelo 17 , Giuseppe Reimondo 2 & Martin Fassnacht 15
1Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy, Bologna, Italy; 2Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Orbassano, Italy, Torino, Italy; 3Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital Würzburg, Würzburg, Germany; Medicover Oldenburg MVZ, Oldenburg, Germany, Oldenburg, Germany; 4Division of Endocrinology, Mayo Clinic, Rochester, MN, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, US, Rochester, MN, United States; 5Department of Clinical, Internal, Anesthesiological and Cadiological Sciences, University Sapienza, Rome, Italy, Rome, Italy; 6Division of Endocrinology, Diabetes and Metabolism, University of Turin, Turin, Italy, Turin, Italy; 7Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76 Stockholm, Sweden; Department of Endocrinology, Karolinska University Hospital, 171 76 Stockholm, Sweden, Stockholm, Sweden; 8Department of Metabolism and Systems Science, College of Medicine and Health, University of Birmingham, Birmingham B152TT, United Kingdom, Birmingham, United Kingdom; 9Department of Endocrinology, Faculty of Medicine, Medical University-Sofia, USHATE "Acad. Iv. Penchev", 2, Zdrave Str, 1431 Sofia, Bulgaria, Sofia, Bulgaria; 102nd Department of Surgery, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece, Athens, Greece; 11Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany, Munich, Germany; 12Endocrinology, Clinica Polispecialistica San Carlo, Paderno, Milano, Milano, Italy; 13Azienda Ospedaliera Sant’Andrea, Endocrinology, Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, Rome, Italy, Rome, Italy; 14Endocrinology Unit, Department of Medicine-DIMED, University of Padova, Via Ospedale Civile, Padova, 105 - 35128, Italy, Padova, Italy, 15Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital Würzburg, Würzburg, Germany, Wuerzburg, Germany; 16Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden and Department of Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden, Stockholm, Sweden; 17Research and Innovation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy, Bologna, Italy
JOINT1041
Background: The efficacy of adrenalectomy in adenomas associated with Mild Autonomous Cortisol Secretion (MACS) is poorly investigated. A few small randomized trials and retrospective studies showed beneficial effects of adrenalectomy on hypertension. Long-term data on cardiovascular outcomes are missing.
Aim: To investigate cardiovascular outcomes in patients with unilateral adrenal adenomas and MACS after adrenalectomy.
Methods: Patients with MACS due to unilateral adrenal adenomas (serum cortisol after dexamethasone suppression test [DST] >1.8 mg/dl) from 14 ENSAT centers were included. Clinical data were retrieved at the time of initial evaluation (before adrenal surgery) and at last follow-up. From each center, MACS patients with and without surgery were matched 1:1. The control group belonged to a previously published study on long-term outcomes of MACS1. Matching was performed by propensity score using age and sex. We considered the following outcomes (occurring after adrenalectomy or after initial diagnosis in non-operated patients): new cardiovascular events (CVE), CVE and death from cardiovascular causes (composite-CVE), and death from all causes. We performed survival and multivariable Cox-regression analyses.
Results: We included 616 patients: 308 were treated by adrenalectomy and 308 underwent follow-up. Mean age was 58.1±10.5 years for both groups (P=0.927). Prevalence of female sex was 67.2% (n=207) vs 67.9% (n=209) (P=0.931). The prevalence of hypertension and diabetes at baseline was not different between groups (P=0.127 and P=1.000, respectively). Values of post-DST cortisol were higher in operated patients than in non-operated ones (4.6±3.7 vs 3.7±3.2 mg/dl; P<0.001). After a median follow-up of 5 years (range 1 to 15 years), survival analysis showed significant differences between operated and non-operated patients for both new-CVE (HR: 0.554, 95%CI: 0.333-0.922, P=0.023) and composite CVE (HR: 0.581, 95%CI: 0.402-0.839, P=0.004). No significant differences were detected for all-cause mortality (HR: 0.772, 95%CI: 0.496-1.202, P=0.251). The multivariable Cox-regression analysis confirmed the significant beneficial effect of surgery on new CVE and composite-CVE after adjustment for cortisol after DST (HR: 0.565, 95%CI: 0.335-0.951, P=0.032 and HR: 0.573, 95%CI: 0.394-0.835, P=0.004, respectively).
Conclusion: Treatment of unilateral adenomas and MACS with adrenalectomy improves long-term cardiovascular outcomes.
Reference: 1. Deutschbein, Lancet Diabetes Endocrinol Metab, 2022.
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