Beneficial metabolic effects of prompt surgical treatment in patients with an adrenal incidentaloma causing biochemical hypercortisolism
Abstract
CONTEXT: In patients with adrenal incidentalomas, subclinical hypercortisolism (SH) is associated with an increased prevalence of the metabolic syndrome. The effect of surgical/conservative approach is debated. OBJECTIVE: The objective of the study was to determine the effect of the surgical and conservative approaches on the metabolic syndrome in patients with adrenal incidentalomas. DESIGN: This was a retrospective longitudinal study (18-48 months follow-up). SETTING: The study was conducted on an in- and outpatient basis. PATIENTS: One hundred eight patients with adrenal incidentalomas were studied for the presence of SH, which was diagnosed in the presence of more than two of the following: urinary free cortisol greater than 70 microg per 24 h (193 nmol per 24 h), cortisol after 1 mg dexamethasone suppression test greater than 3.0 microg/dl (83 nmol/liter), ACTH less than 10 pg/ml (2.2 pmol/liter). INTERVENTIONS: Surgery was performed in 25 patients with SH (group TrSH+) and 30 without SH (group TrSH-), whereas the conservative approach was chosen by 16 patients with SH (group UntrSH+) and 37 without SH (group UntrSH-). MAIN OUTCOME MEASURES: During the follow-up, the improvement/worsening of body weight, blood pressure, or glucose and cholesterol levels was defined in the presence of a greater than 5% weight decrease/increase and following the European Society of Cardiology or the Adult Treatment Panel III criteria, respectively. RESULTS: In group TrSH+, weight, blood pressure, and glucose levels improved (32, 56, and 48%, respectively) more frequently than in group UntrSH+ (12.5%, P = 0.05; 0.0%, P < 0.0001; 0.0%, P = 0.001; and 0.0%, P = 0.0014, respectively). In group UntrSH+, blood pressure, glucose, and low-density lipoprotein levels worsened more frequently (50.0, 37.5, and 50.0%, respectively) than in group TrSH+ (0.0%, P < 0.0001; 0.0%, P = 0.001; and 20.0%, P = 0.05, respectively). CONCLUSIONS: Regarding the various components of the metabolic syndrome, in patients with adrenal incidentalomas and SH, surgery is beneficial.
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Metabolic improvement after adrenalectomy, including weight loss, blood pressure lowering, glucose tolerance, lower lipids, and beneficial effects on bone, has been reported.
“Metabolic improvement after adrenalectomy, including weight loss, blood pressure lowering, glucose tolerance, lower lipids, and beneficial effects on bone have been reported (230,267).”
From Adrenal incidentaloma (2020) · cites this paper as [230]
Most studies of surgical intervention for ACS involve small numbers and are retrospective, uncontrolled, and lack randomization.
“Several studies have reported the outcome of surgical intervention but most involve small numbers and are retrospective, uncontrolled, and lack randomization (230,243,250-253,255) (Table 7).”
From Adrenal incidentaloma (2020) · cites this paper as [230]
Few studies have evaluated the accuracy of preoperative subclinical hypercortisolism diagnosis to predict improvement after surgery.
“Few studies evaluated the accuracy of the SH diagnosis before surgery to predict the improvement after surgery and, therefore, to address the treatment of choice in the individual subject (18,46,61,93).”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [61]
Some surgically treated patients without subclinical hypercortisolism experienced improvement of some metabolic endpoints.
“This is of utmost importance because in several studies some of the surgically treated patients without SH experienced improvement of some metabolic endpoints (18,46,61,93).”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [61]
In surgically untreated subclinical hypercortisolism patients, blood pressure, glucose, and cholesterol worsened more frequently (50.0%, 37.5%, 50.0%) than in surgically treated patients (0%, 0%, 24%).
“On the contrary, in surgically untreated SH patients, blood pressure, glucose, and cholesterol levels worsened more frequently (50.0, 37.5, and 50.0%, respectively) than in surgically treated patients (0, 0, and 24%, respectively) (61).”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [61]
In a retrospective nonrandomized study, 25 surgically treated subclinical hypercortisolism patients had improvement in body weight, blood pressure, and glucose levels (32%, 56%, 48%) more frequently than untreated SH subjects (12.5%, 0%, 0%).
“In a retrospective, nonrandomized study, we reported that in 25 surgically treated SH patients, body weight, blood pressure, and glucose levels improved (32, 56, and 48%, respectively) more frequently than in untreated SH subjects (12.5, 0.0, and 0.0%, respectively) (61).”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [61]
In some patients with subclinical hypercortisolism not operated on, bone mineral density, fasting glucose, blood pressure, and cholesterol levels have been shown to worsen during follow-up.
“Similarly, because in some patients with SH not operated on, bone mineral density, fasting glucose, blood pressure, and cholesterol levels have been shown to worsen during follow-up (49, 61)”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [61]
Available data suggest a possible deleterious role of subclinical hypercortisolism, at least on glucose and bone metabolism and on hypertension, even in patients adequately followed with antihypertensive and antidiabetic medical therapy.
“the available data suggest a possible deleterious role of SH, at least on glucose and bone metabolism and on hypertension, even in patients adequately followed up with antihypertensive and antidiabetic medical therapy (61).”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [61]
Uncertainties about diagnosis and surgery bring into question the real clinical importance of subclinical hypercortisolism and the need for surgical treatment instead of optimized medical therapy.
“These uncertainties, in turn, bring into question the real clinical importance of SH itself and the need of a surgical treatment in these patients instead of the optimization of medical therapy (61).”
From Diagnosis and Treatment of Subclinical Hypercortisolism (2011) · cites this paper as [61]
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BackgroundDiagnosis and Treatment of Subclinical Hypercortisolism
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- Authors
- Chiodini, I., Morelli, V., Salcuni, A. S., Eller-Vainicher, C., Torlontano, M., Coletti, F., Iorio, L., Cuttitta, A., Ambrosio, A., Vicentini, L., Pellegrini, F., Copetti, M., Beck-Peccoz, P., Arosio, M., Ambrosi, B., Trischitta, V., & Scillitani, A.
- Affiliations
- Department of Medical Sciences (I.C., V.M., A.S.S., C.E.-V., P.B.-P., M.A.), San Donato Institute, San Donato Milanese, 20122 Milan, Italy
- Casa Sollievo della Sofferenza (IT)
- Ospedale San Giuseppe (IT)
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
- University of Milan (IT)
- Corresponding author
- Chiodini, Iacopo
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2010-06-01
- Volume
- 95
- Issue
- 6
- Pages
- 2736-2745
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2139061427
- Semantic Scholar
- def83fa11c628e121412927601cdf15281915ed5
- Cited by
- 191
- References
- 43
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 2 · 2023: 10 · 2022: 5 · 2021: 9 · 2020: 8 · 2019: 6 · 2018: 14 · 2017: 8 · 2016: 18 · 2015: 19 · 2014: 18 · 2013: 12 · 2012: 21
- FWCI
- 20.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Keywords
- adrenal incidentaloma, subclinical hypercortisolism, metabolic syndrome, adrenalectomy, conservative treatment, body weight, blood pressure, glucose, cholesterol, urinary free cortisol, ACTH, dexamethasone suppression test
- MeSH terms
- Adrenal Gland Neoplasms, Adrenocorticotropic Hormone, Adult, Aged, Blood Glucose, Blood Pressure, Body Weight, Cholesterol, Cushing Syndrome, Dexamethasone, Female, Follow-Up Studies, Humans, Hydrocortisone, Cholesterol, LDL, Longitudinal Studies, Male, Middle Aged, Thyrotropin, Treatment Outcome, Metabolic Syndrome
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