The DOI matches its Crossref record; 21 of the 21 references it cites were found in a registry or an index.
Surgical Versus Conservative Management for Subclinical Cushing Syndrome in Adrenal Incidentalomas: A Prospective Randomized Study
Open accessAbstract
OBJECTIVE: To compare the clinical outcome of patients with subclinical Cushing syndrome (SCS) due to an adrenal incidentaloma (the autonomous hypersecretion of a small amount of cortisol, which is not enough to cause clinically-evident disease) who underwent surgery or were managed conservatively. SUMMARY BACKGROUND DATA: The most appropriate management of SCS patients is controversial, either adrenalectomy or close follow-up being recommended for their treatment. METHODS: Over a 15-year period, 45 SCS patients were randomly selected to undergo surgery (n = 23) or conservative management (n = 22). All surgical procedures were laparoscopic adrenalectomies performed by the same surgeon. All patients were followed up (mean, 7.7 years; range, 2-17 years) clinically by 2 experienced endocrinologists 6 and 12 months after surgery and then yearly, or yearly after joining the trial, particularly monitoring diabetes mellitus (DM), arterial hypertension, hyperlipidemia, obesity, and osteoporosis. The study end point was the clinical outcome of SCS patients who underwent adrenalectomy versus those managed conservatively. RESULTS: All 23 patients in the surgical arm had elective surgery. Another 3 patients randomly assigned to conservative management crossed over to the surgical group due to an increasing adrenal mass >3.5 cm. In the surgical group, DM normalized or improved in 62.5% of patients (5 of 8), hypertension in 67% (12 of 18), hyperlipidemia in 37.5% (3 of 8), and obesity in 50% (3 of 6). No changes in bone parameters were seen after surgery in SCS patients with osteoporosis. On the other hand, some worsening of DM, hypertension, and hyperlipidemia was noted in conservatively-managed patients. CONCLUSIONS: Based on the results of this study, laparoscopic adrenalectomy performed by skilled surgeons appears more beneficial than conservative management for SCS patients complying with our selection criteria. This trial is registered with Australian Clinical Trials Registry number, ANZCTR12608000567325.
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Cites
Management of the clinically inapparent adrenal mass ("incidentaloma")
Grumbach, M. M., Biller, B. M. K., Braunstein, G. D., Campbell, K. K., Carney, J. A., Godley, P. A., Harris, E. L., Lee, J. K. T., Oertel, Y. C., Posner, M. C., et al. (2003) · Annals of Internal Medicine · doi:10.7326/0003-4819-138-5-200303040-00013 · Cited by 945
A Survey on Adrenal Incidentaloma in Italy
Mantero, F. (2000) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.85.2.637 · Cited by 907
Arlt, W., & Allolio, B. (2003) · The Lancet · doi:10.1016/s0140-6736(03)13492-7 · Cited by 819
Rossi, R., Tauchmanovà, L., Luciano, A., Martino, M. D., Battista, C., Viscovo, L. D., Nuzzo, V., & Lombardi, G. (2000) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.85.4.6515 · Cited by 416
Tauchmanovà, L., Rossi, R., Biondi, B., Pulcrano, M., Nuzzo, V., Palmieri, E.-A., Fazio, S., & Lombardi, G. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2001-011766 · Cited by 400
Assalia, A., & Gagner, M. (2004) · British journal of surgery · doi:10.1002/bjs.4738 · Cited by 308
Subclinical Cushing’s syndrome
Reincke, M. (2000) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/s0889-8529(05)70115-8 · Cited by 285
Subclinical Cushing’s syndrome in adrenal incidentalomas
Terzolo, M., Bovio, S., Reimondo, G., Pia, A., Osella, G., Borretta, G., & Angeli, A. (2005) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2005.01.008 · Cited by 179
Chidiac, R. M., & Aron, D. C. (1997) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/s0889-8529(05)70242-5 · Cited by 140
Study of glucose tolerance in consecutive patients harbouring incidental adrenal tumours
Fernández‐Real, J. M., Ricart Engel, W., Simó, R., Salinas, I., Webb, S. M., & and the Study Group of Incidental Adrenal Adenoma (1998) · Clinical Endocrinology · doi:10.1046/j.1365-2265.1998.00437.x · Cited by 109
Flagged first, then by citations
Research works printed but not linked: 1
- Brunaud, 2006, Observation or laparoscopic adrenalectomy for adrenal incidentaloma?, Med Sci Monit, 12, 355
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Items 201–245 of 245
Advances in our understanding of the prognosis of adrenal incidentaloma
Mackay, I., & Aspinall, S. R. (2016) · Expert Review of Endocrinology & Metabolism · doi:10.1080/17446651.2016.1233055 · Cited by 1
“7 years; however, no benefit was seen in the operated group in osteoporosis [82].”
BackgroundLirov, R., & Gauger, P. G. (2018) · Springer eBooks · doi:10.1007/978-981-10-1124-5_26 · Cited by 1
Ragnarsson, Ó. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-96120-2.00006-6 · Cited by 1
The Hormonal Status Comparison of Unilateral and Bilateral Adrenal Adenomas: Are They the Same?
Özbaş, B., Canpolat, A. G., Özbaş, C., Çorapçıoğlu, D., & Şahi̇n, M. (2023) · European Journal of Therapeutics · doi:10.58600/eurjther665
“Although they were initially thought to be hormonally nonfunctioning, up to 20% of adrenal incidentalomas secrete hormones [15].”
InfluentialNebennieren-Inzidentalom/Subklinisches Cushing-Syndrom: Wann besteht eine OP-Indikation?
Faßnacht, M. (2010) · Journal für Kardiologie (Krause & Pachernegg GmbH) · Cited by 1
Cushing’s Syndrome and Cardiovascular Risk
Anagnostis, P. G., & Goulis, D. G. (2019) · Current Vascular Pharmacology · doi:10.2174/1570161117999190318142847 · Cited by 1
Valeri, A., & Bergamini, C. (2012) · Springer eBooks · doi:10.1007/978-88-470-2586-8_14
“A high grade evidence study has demonstrated that pre-Cushing’s disease has to be treated laparoscopically early since it tends very often to evolve to the overt disease [12].”
BackgroundAdrenal Incidentalomas and Arterial Hypertension
Παππά, Θ., Kaltsas, G., Piaditis, G. P., & Chrousos, G. P. (2012) · Humana Press eBooks · doi:10.1007/978-1-60761-548-4_6
Nebennieren und Diabetes mellitus
Weismann, D., & Allolio, B. (2009) · Der Diabetologe · doi:10.1007/s11428-009-0436-7
Brunt, L. M., & Varela, J. E. (2011) · Springer eBooks · doi:10.1007/978-1-4419-7901-8_30
Long term follow-up of benign functional adrenocortical tumors in the era of robotic surgery
Nilsson, M., Almqvist, M., & Nordenström, E. (2012) · Endocrinology Studies · doi:10.4081/es.2012.e4
Hipercortisolismo de origen suprarrenal: síndrome de Cushing
Blasco, F. Á., Buesa, M. A., Luque‐Ramírez, M., & Escobar-Morreale, H. F. (2012) · Medicine - Programa de Formación Médica Continuada Acreditado · doi:10.1016/s0304-5412(12)70398-0
Adrenal Incidentalomas with Supraphysiologic Response to ACTH Stimulus: A Case Report
Antonopoulou, M., & Perelstein, A. (2012) · Case Reports in Endocrinology · doi:10.1155/2012/503290
“However, according to one small study it appeared that surgical adrenalectomy was more beneficial than medical management as it improved the possible metabolic consequences like diabetes and hypertension, which are important risk factors for increased morbidity and mortality [2, 17].”
BackgroundBilateral adrenal tumors with subclinical hypercortisolemia. To operate or observe
Papierska, L., & Nowak, K. M. (2014) · Postępy Nauk Medycznych
L'incidentalome surrénalien, étude du statut métabolique et de la fibrinolyse
Thebert, J. (2015) · HAL
Bohdanowicz-Pawlak, A., Szymczak, J., Waszczuk, E., Bolanowski, M., & Therapy, I. (2013)
Management Scheme for Adrenal Incidentalomas: Who Gets What?
Callender, G. G., & Udelsman, R. (2016) · Current Surgery Reports · doi:10.1007/s40137-016-0145-2
Operative Techniques for Adrenal Neoplasms
Patel, D. (2016) · Springer eBooks · doi:10.1007/978-3-319-44136-8_13
Current Management of Adrenal Incidentalomas
Michailidou, M., & Guerrero, M. A. (2017) · InTech eBooks · doi:10.5772/intechopen.68774
Cirugía del incidentaloma suprarrenal
Chinelli, J. (2017) · Revista Médica del Uruguay · doi:10.29193/rmu.33.4.1
Kang, M., Baek, M., Lee, J., & Jeong, B. C. (2017) · Journal of Urologic Oncology · doi:10.22465/kjuo.2017.15.3.137
“5% (3 of 8), and obesity in 50% (3 of 6) in the surgical group, whereas some patients demonstrated worsening of diabetes and hypertension in the conservative treatment group.(11) Miyazato et al.”
BackgroundPhan, A. T., Habra, M. A., Grubbs, E. G., & Moran, C. A. (2012) · Wiley eBooks · doi:10.1002/9781118464557.ch10
Therapy of mild cortisol excess
Iqbal, A., & Newell-Price, J. D. C. (2019) · Current Opinion in Endocrine and Metabolic Research · doi:10.1016/j.coemr.2019.08.019
Akın, Ş., Dağdelen, S., Yıldız, B. O., Gürlek, A., Erbas, T. A., & Bayraktar, M. (2020) · Kocatepe tıp dergisi. · doi:10.18229/kocatepetip.507301
Subclinical Cushing’s syndrome, renal carcinoma, adrenal adenoma, adrenal incidentaloma.
Liu, C. (2020) · Acta Endocrinologica (Bucharest) · doi:10.4183/aeb.2020.97
Subklinischer) Hyperkortisolismus als mögliche endokrine Hypertonieursache
Stepan, V. M. (2013)
Surrenal Kitle Saptanan Hastaların Klinik, Labaratuar ve Radyolojik Bulguları; Tek Merkez Deneyimi
Tabur, S., Ozturk, S. S., AĞCABAY, O., Akarsu, E., & Araz, M. (2021) · Harran Üniversitesi Tıp Fakültesi Dergisi · doi:10.35440/hutfd.884977
Palazzo, F. F., & Mihai, R. (2022) · doi:10.1093/med/9780198870197.003.0094
Long term follow-up of benign functional adrenocortical tumors in the era of robotic surgery
Nilsson, M., Almqvist, M., & Nordenström, E. (2012) · Endocrinology Studies · doi:10.4081/4336
(2009) · British journal of surgery · doi:10.1002/bjs.6799
Balasubramanian, S. P., & Harrison, B. J. (2011) · doi:10.1093/med/9780199235292.003.0522
Trandafir, A.-I., Stanciu, M., Albu, S. E., Stoian, V. R., CIOFU, I., Persu, C., Nistor, C., & Carşote, M. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12134244
“…nmol/L) Chiodini 2009 [59] Case-control study ≥2 out of: Serum cortisol after 1 mg DST >82.8 nmol/L (>3 µg/dL) Low ACTH < 2.2 pmol/L High UFC > 193.1 nmol/L Toniato 2009 [60] Prospective study Serum cortisol after 1 mg DST > 2.5 µg/dL Morelli 2010 [61] Retrospective study ≥2 out of: Serum…”
BackgroundMethodInfluentialProgress in Subclinical Cushing’s Syndrome
赵, 陆. (2023) · Advances in Clinical Medicine · doi:10.12677/acm.2023.13122671
Llavero-Valero, M., Vaamonde, J., & Buey, G. G. (2023) · Medicine - Programa de Formación Médica Continuada Acreditado · doi:10.1016/j.med.2023.12.002
Avaliação dos tumores adrenais e análise do perfil metabólico de pacientes com incidentaloma
MONTALVÃO, P. V. G., MANGUEIRA, I. M., ALVES, G. D. M., CORDEIRO, J. V. F., Soares-Mota, M., & RAVANINI, G. D. A. G. (2024) · Revista do Colégio Brasileiro de Cirurgiões · doi:10.1590/0100-6991e-20243685
Faßnacht, M. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-13825-6.00266-1
Ferrière, A., & Tabarin, A. (2025) · Médecine des Maladies Métaboliques · doi:10.1016/j.mmm.2025.07.002
Pivonello, R., Simeoli, C., Paola, N. D., & Colao, A. A. L. (2025) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaf447
Chirurgia, terapia medica o follow-up nella secrezione autonoma di cortisolo (MACS)?
Morelli, V., Ceccato, F., & Dalmazi, G. D. (2026) · L Endocrinologo · doi:10.1007/s40619-026-01754-w
“La significatività statistica è stata raggiunta per l’ipertensione [9]; - RCT successivo su 55 pazienti (follow-up 6 mesi): la surrenectomia ha comportato un miglioramento pressorio nel 68% dei casi, rispetto a solo il 13% nel gruppo osser-vazionale.”
Milde autonome Cortisolsekretion (MACS) – Komorbiditäten und Therapieansätze
Theiler‐Schwetz, V., Trummer, C., Pilz, S., & Schmitt, L. (2026) · Journal für Endokrinologie Diabetologie und Stoffwechsel · doi:10.1007/s41969-026-00294-w
Surgical issues for a patient with Cushing's syndrome: Techniques, complications, and recovery
Dinerman, A. J., & Nilubol, N. (2026) · Elsevier eBooks · doi:10.1016/b978-0-323-96100-4.00009-0
Swaminathan, N., Song, Z., Abraham, P., Gillis, A., Fazendin, J. M., Chen, H. Y., & Lindeman, B. M. (2026) · Surgery · doi:10.1016/j.surg.2026.110238
MACS: mild by definition, challenging by nature
Bluszcz, G., Roszkowska, Z., Domański, J., Sharabi, A., Rapiejko, J., Malek, J., Ambroziak, U., & Bobrowicz, M. (2026) · Frontiers in Endocrinology · doi:10.3389/fendo.2026.1957127
Metadata
- Authors
- Toniato, A., Merante-Boschin, I., Opocher, G., Pelizzo, M. R., Schiavi, F., & Ballotta, E.
- Affiliations
- University of Padua (IT)
- Istituto Oncologico Veneto (IT)
- Corresponding author
- Toniato, Antonio
- Pelizzo, Maria R.
- Schiavi, Francesca
- Venue
- Annals of Surgery
- Published
- 2009-03
- Volume
- 249
- Issue
- 3
- Pages
- 388-391
- ISSN
- 0003-4932 (ISSN-L)
- OpenAlex
- W2067421446
- Cited by
- 245
- References
- 21
- Citations by year
- 2026: 10 · 2025: 10 · 2024: 6 · 2023: 14 · 2022: 11 · 2021: 12 · 2020: 10 · 2019: 13 · 2018: 10 · 2017: 13 · 2016: 25 · 2015: 15 · 2014: 18 · 2013: 17 · 2012: 24
- FWCI
- 20.56
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- other-oa
- Locations
- Annals of Surgery (publishedVersion)
- PubMed (publishedVersion)
- Padua Research Archive (University of Padova) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- subclinical Cushing's syndrome, adrenal incidentaloma, laparoscopic adrenalectomy, conservative treatment, cortisol hypersecretion, diabetes mellitus, hypertension, hyperlipidemia, obesity, osteoporosis, long-term clinical outcomes
- MeSH terms
- Adrenal Gland Neoplasms, Adrenalectomy, Aged, Cushing Syndrome, Female, Humans, Male, Middle Aged, Laparoscopy, Prospective Studies, Incidental Findings
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