Beneficial metabolic effects of prompt surgical treatment in patients with an adrenal incidentaloma causing biochemical hypercortisolism.
BACKGROUND
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.


METHODS
This was a retrospective longitudinal study (18-48 months follow-up).


METHODS
The study was conducted on an in- and outpatient basis.


METHODS
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).


METHODS
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-).


METHODS
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.
Chiodini
Iacopo
I
Department of Medical Sciences, University of Milan, 20122 Milan, Italy. iacopo.chiodini@email.it
Morelli
Valentina
V
Salcuni
Antonio Stefano
AS
Eller-Vainicher
Cristina
C
Torlontano
Massimo
M
Coletti
Francesca
F
Iorio
Laura
L
Cuttitta
Antonello
A
Ambrosio
Angelo
A
Vicentini
Leonardo
L
Pellegrini
Fabio
F
Copetti
Massimiliano
M
Beck-Peccoz
Paolo
P
Arosio
Maura
M
Ambrosi
Bruno
B
Trischitta
Vincenzo
V
Scillitani
Alfredo
A
D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000378:metabolism* / Q000601:surgery*; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology; D001835:Body Weight / Q000502:physiology; D002784:Cholesterol / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003480:Cushing Syndrome / Q000209:etiology / Q000378:metabolism* / Q000601:surgery*; D003907:Dexamethasone; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D008137:Longitudinal Studies; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood; D008875:Middle Aged; D013972:Thyrotropin / Q000097:blood; D016896:Treatment Outcome
D001786:Blood Glucose; D008078:Cholesterol, LDL; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D013972:Thyrotropin; D002784:Cholesterol; D006854:Hydrocortisone