The DOI matches its Crossref record; 43 of the 43 references it cites were found in a registry or an index.
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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In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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 the citing paper
“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 the citing paper
“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 the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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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“Metabolic improvement after adrenalectomy, including weight loss, blood pressure lowering, glucose tolerance, lower lipids, and beneficial effects on bone have been reported (230,267).”
BackgroundDiagnosis and Treatment of Subclinical Hypercortisolism
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“Although an improvement in CVR factors after the removal of AI causing SCS appears to be beneficial (42, 43), the available data regarding a similar approach in NFAIs are conflicting.”
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“We used these criteria because they have been substantiated previously on a clinical basis.((24-27)) On the basis of these criteria, at baseline, 20 and 83 patients were defined as affected or unaffected with SH (SHþ and SH, respectively).”
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“Although independent medical treatment of cardiovascular risk factors may represent a reasonable long-term management strategy for individuals with SH, recent advances in laparoscopic and retroperitonoscopic adrenalectomy raise the possibility of a potentially curative intervention for a subgroup of patients (13, 14).”
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“Recently, tests of the HPA axis associated with known metabolic consequences of hypercortisolemia in these individuals have been suggested [32], but benefit from adrenal surgery has been demonstrated in subjects without ‘subclinical hypercortisolemia’ [26].”
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“In one case series, patients with both metabolic syndrome and an adrenal incidentaloma benefited from adrenalectomy (101).”
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“nature, nonrandomized treatment decisions, and potential bias [1,2,20,21].”
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“Current trends vary widely: from those that support a possible detrimental effect of long-acting subclinical hypercortisolism if left untreate”
BackgroundSubclinical hypercortisolism in adrenal incidentaloma
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“Results from studies have been conflicting but in general data indicate an improvement in metabolic complications, especially in blood pressure and diabetes, in some patients after adrenal surgery, and deterioration or no improvement in patients treated conservatively [15,45].”
ResultIvović, M., Marina, L., Vujović, S., Tančić‐Gajić, M., Stojanovic, M. M., Radonjić, N. V., Gajić, M. M., Soldatović, I., & Micić, D. (2013) · Metabolism · doi:10.1016/j.metabol.2012.12.006 · Cited by 35
“(2010) suggest that the use of 3 parameters – 1 mg-DST (with cutoff >83 nmol/L), high UFC and low ACTH – is the best method to properly diagnose SCS [42].”
BackgroundMethodSubclinical Cushing’s syndrome: Current concepts and trends
Zografos, G. N., Perysinakis, I., & Vassilatou, E. (2014) · HORMONES · doi:10.14310/horm.2002.1506 · Cited by 33
Prediction of Vertebral Fractures in Patients With Monolateral Adrenal Incidentalomas
Morelli, V., Eller-Vainicher, C., Palmieri, S., Cairoli, E., Salcuni, A. S., Scillitani, A., Carnevale, V., Corbetta, S., Arosio, M., Casa, S. D., et al. (2016) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2016-1423 · Cited by 34
Self-citationPetramala, L., Cavallaro, G., Galassi, M., Marinelli, C., Tonnarini, G., Concistrè, A., Costi, U., Bufi, M., Lucia, P., Vincentis, G. D., et al. (2017) · High Blood Pressure & Cardiovascular Prevention · doi:10.1007/s40292-017-0182-7 · Cited by 34
“At today, the optional treatment of SH due to AI is not yet defined and remains challenge [6, 7].”
BackgroundResultFrequently asked questions and answers (if any) in patients with adrenal incidentaloma
Ceccato, F., Barbot, M., Scaroni, C. M., & Boscaro, M. (2021) · Journal of Endocrinological Investigation · doi:10.1007/s40618-021-01615-3 · Cited by 35
Clinical outcome of subclinical Cushing's syndrome after surgical and conservative treatment
Akaza, I., Yoshimoto, T., Iwashima, F., Nakayama, C., Doi, M., Izumiyama, H., & Hirata, Y. (2011) · Hypertension Research · doi:10.1038/hr.2011.90 · Cited by 34
Recent Updates on the Management of Adrenal Incidentalomas
Park, S. S., & Kim, J. H. (2023) · Endocrinology and Metabolism · doi:10.3803/enm.2023.1779 · Cited by 39
“As stated in the 2023 ESE guideline, there is currently a lack of randomized controlled trials for cardiovascular outcomes or mortality comparing conservative and surgical treatment, although some studies have demonstrated a decrease in comorbidities following surgical treatment [7,15,16].”
Kim, B., Chun, A. R., Kim, K.-J., Jung, C., Kang, S. K., Mok, J., & Kim, C. (2014) · Endocrinology and Metabolism · doi:10.3803/enm.2014.29.4.457 · Cited by 32
Outcome of adrenalectomy for subclinical hypercortisolism and Cushing syndrome
Raffaelli, M., Crea, C. D., D’Amato, G., Gallucci, P., Lombardi, C. P., & Bellantone, R. D. A. (2016) · Surgery · doi:10.1016/j.surg.2016.07.042 · Cited by 32
Laparoscopic adrenalectomy in patients with subclinical Cushing syndrome
Perysinakis, I., Marakaki, C., Avlonitis, S., Katseli, A., Vassilatou, E., Papanastasiou, L., Piaditis, G., & Zografos, G. N. (2013) · Surgical Endoscopy · doi:10.1007/s00464-012-2730-5 · Cited by 30
“Recent studies have confirmed better management of SCS by LA, emphasizing the improvement of several components of metabolic syndrome and the decrease in cardiovascular risk [8, 9, 24].”
BackgroundResultCastro, M. A., Ojeda, C. M., Ramírez, M. N. S., Santos, V. G. D., Corrales, E. P., & Fernández-Argüeso, M. (2022) · Endocrine · doi:10.1007/s12020-022-03120-w · Cited by 30
Urinary glucocorticoid metabolites: biomarkers to classify adrenal incidentalomas?
Brossaud, J., Ducint, D., & Corcuff, J. (2015) · Clinical Endocrinology · doi:10.1111/cen.12717 · Cited by 30
Ricciato, M. P., Donna, V. D., Perotti, G., Pontecorvi, A., Bellantone, R. D. A., & Corsello, S. M. (2014) · World Journal of Surgery · doi:10.1007/s00268-014-2482-6 · Cited by 33
Possible, probable, and certain hypercortisolism: A continuum in the risk of comorbidity
Castro, M. A., Corrales, E. P., & Lamas, C. (2023) · Annales d Endocrinologie · doi:10.1016/j.ando.2023.01.005 · Cited by 36
Ioachimescu, A. G., Remer, E. M., & Hamrahian, A. H. (2015) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2015.02.005 · Cited by 28
Ayala, A. R., & Manzano, A. J. (2014) · Journal of Neuro-Oncology · doi:10.1007/s11060-014-1508-0 · Cited by 27
A multidisciplinary approach to the management of adrenal incidentaloma
Voltan, G., Boscaro, M., Armanini, D., Scaroni, C. M., & Ceccato, F. (2021) · Expert Review of Endocrinology & Metabolism · doi:10.1080/17446651.2021.1948327 · Cited by 27
“reported metabolic and cardiovascular improvement (weight, blood pressure, and glucose levels) in patients with autonomous cortisol secretion after surgery [110,111].”
BackgroundCurrent status and controversies in adrenal incidentalomas
Kaltsas, G., Chrisoulidou, A., Piaditis, G. P., Kassi, E. N., & Chrousos, G. P. (2012) · Trends in Endocrinology and Metabolism · doi:10.1016/j.tem.2012.09.001 · Cited by 26
Screening for ACTH-dependent hypercortisolism in patients affected with pituitary incidentaloma
Toini, A., Dolci, A., Ferrante, E., Verrua, E., Malchiodi, E., Sala, E., Lania, A. G., Chiodini, I., Beck‐Peccoz, P., Arosio, M., et al. (2015) · European Journal of Endocrinology · doi:10.1530/eje-14-0599 · Cited by 26
Self-citationCastro, M. A., Reincke, M., & Lamas, C. (2023) · Biomedicines · doi:10.3390/biomedicines11123115 · Cited by 24
“There are several studies that demonstrate the benefit of surgical treatment in terms of improving the glucometabolic profile of patients with MACS [53–55].”
BackgroundScreening for secondary endocrine hypertension in young patients.
Trifanescu, R. A., Carşote, M., Caragheorgheopol, A., Hortopan, D., Dumitrascu, A. S., Dobrescu, M., & Poiană, C. (2013) · Europe PMC (PubMed Central) · Cited by 24
Khadembashiri, M. M., Mohseni, S., Harandi, H., Sani, M. P., Khadembashiri, M. A., Atlasi, R., SeyedAlinaghi, S., Mohajeri‐Tehrani, M. R., & Larijani, B. A. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1374711 · Cited by 24
Evaluation of patients with adrenal incidentalomas
Kannan, S., Remer, E. M., & Hamrahian, A. H. (2013) · Current Opinion in Endocrinology Diabetes and Obesity · doi:10.1097/med.0b013e328360a43b · Cited by 23
“However, there are only a few studies demonstrating the benefit of adrenalectomy in patients with these metabolic parameters [49].”
BackgroundFavero, V., Aresta, C., Parazzoli, C., Cairoli, E., Eller-Vainicher, C., Palmieri, S., Salcuni, A. S., Arosio, M., Persani, L., Scillitani, A., et al. (2023) · Cardiovascular Diabetology · doi:10.1186/s12933-023-01836-1 · Cited by 22
Self-citationAge and the metabolic syndrome affect salivary Cortisol rhythm: data from a community sample
Ceccato, F., Barbot, M., Zilio, M., Ferasin, S., Lazzari, P. D., Lizzul, L., Boscaro, M., & Scaroni, C. M. (2015) · HORMONES · doi:10.14310/horm.2002.1591 · Cited by 22
Costa, D., Conceição, F. L., Leite, N. C., Ferreira, M. T., Salles, G. F., & Cardoso, C. R. L. (2016) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2016.05.006 · Cited by 22
Johnson, P., Thompson, S. M., Adamo, D. A., Fleming, C. J., Bancos, I., McKenzie, T. J., Cheville, J. C., Young, W. F., & Andrews, J. C. (2022) · Clinical Endocrinology · doi:10.1111/cen.14833 · Cited by 21
“In appropriate candidates, adrenalectomy is preferred as it has been shown to be more beneficial than conservative management.(7,8) For patients with bilateral adrenal masses, treatment planning is more complex since masses can occur in various combinations such as a unilateral cortisol‐secreting adenoma with a contra…”
BackgroundKawate, H., Kohno, M., Matsuda, Y., Akehi, Y., Tanabe, M., Horiuchi, T., Ohnaka, K., Nomura, M., Yanase, T., & Takayanagi, R. (2014) · Endocrine Journal · doi:10.1507/endocrj.ej14-0155 · Cited by 21
Comorbidities in Mild Autonomous Cortisol Secretion – A Clinical Review of Literature
Czapla-Iskrzycka, A., Świątkowska−Stodulska, R., & Sworczak, K. (2022) · Experimental and Clinical Endocrinology & Diabetes · doi:10.1055/a-1827-4113 · Cited by 20
Khan, U. (2019) · Indian Journal of Endocrinology and Metabolism · doi:10.4103/ijem.ijem_52_19 · Cited by 20
Remde, H., Kranz, S., Morell, S. M., Altieri, B., Kroiß, M., Detomas, M., Faßnacht, M., & Deutschbein, T. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1123132 · Cited by 19
“Overall, the median stay in hospital was 5 (2-24) days.”
BackgroundInfluentialIncreased expression of CYP17 and CYP11B1 in subclinical Cushing's syndrome due to adrenal adenomas
Cao, C., Yang, X., Li, L., Sun, R., Xian, Y., Lv, W., Wang, J., Xu, Y., & Gao, Y. (2011) · International Journal of Urology · doi:10.1111/j.1442-2042.2011.02836.x · Cited by 19
Anderwald, C. H., Tura, A., Gessl, A., Luger, A., Pacini, G., & Krebs, M. (2013) · PLoS ONE · doi:10.1371/journal.pone.0077326 · Cited by 18
“Interestingly, some of these disturbances were at least in part reversible after surgical removal of AI [11].”
BackgroundWhich type 2 diabetes mellitus patients should be screened for subclinical Cushing’s syndrome?
Cansu, G. B., Atılgan, S., Balcı, M. K., Sarı, R., Özdem, S., & Altunbaş, H. (2017) · HORMONES · doi:10.14310/horm.2002.1716 · Cited by 17
Evaluation of Cortisol Production in Aldosterone-Producing Adenoma
Inoue, K., Yamazaki, Y., Tsurutani, Y., Suematsu, S., Sugisawa, C., Saito, J., Omura, M., Sasano, H., & Nishikawa, T. (2017) · Hormone and Metabolic Research · doi:10.1055/s-0043-119878 · Cited by 17
Low investigation rate for adrenal incidentalomas
Bujawansa, S., & Bowen-Jones, D. (2011) · Endocrine · doi:10.1007/s12020-011-9487-9 · Cited by 17
Huayllas, M. K. P., Netzel, B. C., Singh, R. J., & Kater, C. E. (2018) · Laboratory Medicine · doi:10.1093/labmed/lmy005 · Cited by 17
Vieira-Corrêa, M., Giorgi, R. B., de Oliveira, K. C., Hayashi, L. F., Costa‐Barbosa, F. A., & Kater, C. E. (2019) · Journal of Endocrinological Investigation · doi:10.1007/s40618-019-01104-8 · Cited by 20
Papierska, L., Ćwikła, J. B., Rabijewski, M., Glinicki, P., Otto, M., & Kasperlik-Zaluska, A. A. (2015) · Abdominal Imaging · doi:10.1007/s00261-015-0452-6 · Cited by 16
“At least two of the following abnormal results should be found: a cortisol concentration of >3 mcg/dl after dexamethasone, an ACTH concentration of <10 pg/ml, a cortisol concentration of >4 mcg/dl at midnight, and 24-h urinary excretion of free cortisol of >70 mcg [13, 15–17].”
Background
Metadata
- 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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