title: Beneficial metabolic effects of prompt surgical treatment in patients with an adrenal incidentaloma causing biochemical hypercortisolism.
abstract: 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.
authors.affiliation: Department of Medical Sciences, University of Milan, 20122 Milan, Italy. iacopo.chiodini@email.it
authors.forename: Iacopo
authors.initials: I
authors.lastname: Chiodini
authors.forename: Valentina
authors.initials: V
authors.lastname: Morelli
authors.forename: Antonio Stefano
authors.initials: AS
authors.lastname: Salcuni
authors.forename: Cristina
authors.initials: C
authors.lastname: Eller-Vainicher
authors.forename: Massimo
authors.initials: M
authors.lastname: Torlontano
authors.forename: Francesca
authors.initials: F
authors.lastname: Coletti
authors.forename: Laura
authors.initials: L
authors.lastname: Iorio
authors.forename: Antonello
authors.initials: A
authors.lastname: Cuttitta
authors.forename: Angelo
authors.initials: A
authors.lastname: Ambrosio
authors.forename: Leonardo
authors.initials: L
authors.lastname: Vicentini
authors.forename: Fabio
authors.initials: F
authors.lastname: Pellegrini
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Copetti
authors.forename: Paolo
authors.initials: P
authors.lastname: Beck-Peccoz
authors.forename: Maura
authors.initials: M
authors.lastname: Arosio
authors.forename: Bruno
authors.initials: B
authors.lastname: Ambrosi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Trischitta
authors.forename: Alfredo
authors.initials: A
authors.lastname: Scillitani
mesh_terms: 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
chemical_list: D001786:Blood Glucose; D008078:Cholesterol, LDL; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D013972:Thyrotropin; D002784:Cholesterol; D006854:Hydrocortisone