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Cited by 57Adrenal and Paraganglionic TumorsAdrenal Hormones and DisordersHormonal Regulation and Hypertension

Biochemical and clinical benefits of unilateral adrenalectomy in patients with subclinical hypercortisolism and bilateral adrenal incidentalomas

Perogamvros, I, Vassiliadi, D A, Karapanou, O, Botoula, E, Tzanela, M, Tsagarakis, S·2015·European Journal of Endocrinology
DOI 10.1530/eje-15-0566
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Abstract

OBJECTIVE: The treatment of subclinical hypercortisolism in patients with bilateral adrenal incidentalomas (AI) is debatable. We aimed to compare the biochemical and clinical outcome of unilateral adrenalectomy vs a conservative approach in these patients. DESIGN: Retrospective study. METHODS: The study included 33 patients with bilateral AI; 14 patients underwent unilateral adrenalectomy of the largest lesion (surgical group), whereas 19 patients were followed up (follow-up group). At baseline and at each follow-up visit, we measured 0800 h plasma ACTH, midnight serum cortisol (MSF), 24-h urinary-free cortisol (UFC) and serum cortisol following a standard 2-day low-dose-dexamethasone-suppression test (LDDST). We evaluated the following comorbidities: arterial hypertension, impaired glucose tolerance or diabetes mellitus, dyslipidemia and osteoporosis. RESULTS: Baseline demographic, clinical characteristics and the duration of follow-up (53.9±21.3 vs 51.8±20.1 months, for the surgical vs the follow-up group) were similar between groups. At the last follow-up visit the surgical group had a significant reduction in post-LDDST cortisol (2.4±1.6 vs 6.7±3.9 μg/dl, P=0.002), MSF (4.3±2 vs 8.8±4.6 μg/dl, P=0.006) and 24-h UFC (50.1±21.1 vs 117.9±42.4 μg/24 h, P=0.0007) and a significant rise in mean±s.d. morning plasma ACTH levels (22.2±9.6 vs 6.9±4.8 pg/ml, P=0.002). Improvement in co-morbidities was seen only in the surgical group, whereas no changes were noted in the follow-up group. CONCLUSIONS: Our early results show that removal of the largest lesion offers significant improvement both to cortisol excess and its metabolic consequences, without the debilitating effects of bilateral adrenalectomy. A larger number of patients, as well as a longer follow-up, are required before drawing solid conclusions.

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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 [267]

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Authors
Perogamvros, I., Vassiliadi, D. A., Karapanou, O., Botoula, E., Tzanela, M., & Tsagarakis, S.
Affiliations
Evangelismos Hospital (GR)
Corresponding author
Tsagarakis, S
ORCID
Venue
European Journal of Endocrinology
Publisher
Oxford University Press (OUP)
Published
2015-12
Volume
173
Issue
6
Pages
719-725
ISSN
  • 0804-4643 (ISSN-L)
  • 1479-683X
DOI
10.1530/eje-15-0566
OpenAlex
W2102290777
Cited by
57
References
20
Citations by year
2026: 4 · 2025: 5 · 2024: 4 · 2023: 8 · 2022: 3 · 2021: 3 · 2020: 7 · 2019: 7 · 2018: 6 · 2017: 5 · 2016: 5
FWCI
5.37
Type
journal article
Language
en
Open access
closed
Locations
  • European Journal of Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
  • Research Explorer (The University of Manchester) (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
subclinical hypercortisolism, unilateral adrenalectomy, conservative treatment, ACTH, urinary free cortisol, low-dose dexamethasone suppression test, comorbidities, hypertension, diabetes mellitus, osteoporosis, dyslipidemia
MeSH terms
Adrenal Cortex Neoplasms, Adrenal Gland Neoplasms, Adrenalectomy, Aged, Cushing Syndrome, Diabetes Mellitus, Female, Humans, Hydrocortisone, Hypertension, Male, Middle Aged, Osteoporosis, Retrospective Studies, Cohort Studies, Comorbidity, Case-Control Studies, Treatment Outcome, Glucose Intolerance, Adrenocortical Adenoma, Dyslipidemias, Asymptomatic Diseases

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