title: Adrenalectomy may improve cardiovascular and metabolic impairment and ameliorate quality of life in patients with adrenal incidentalomas and subclinical Cushing's syndrome.
abstract: BACKGROUND
  Adrenalectomy represents the definitive treatment in clinically evident Cushing's syndrome; however, the most appropriate treatment for patients with subclinical Cushing's syndrome (SCS) with an adrenal incidentaloma remains controversial. This study was aimed to assess whether adrenalectomy may improve cardiovascular and metabolic impairment and quality of life compared with conservative management.
  
  
  METHODS
  Twenty patients with adrenal incidentaloma underwent laparoscopic adrenalectomy for SCS, whereas 15 were managed conservatively. Hormonal laboratory parameters of corticosteroid secretion, arterial blood pressure (BP), glycometabolic profile, and quality of life (by the SF-36 questionnaire) were compared at baseline and the end of follow-up.
  
  
  RESULTS
  The 2 groups were equivalent concerning all the examined parameters at baseline. In the operative group, laboratory corticosteroid parameters normalized in all patients but not in the conservative-management group (P < .001). In operated patients, a decrease in BP occurred in 53% of patients, glycometabolic control improved in 50%, and body mass index decreased; in contrast, no improvement or some worsening occurred in the conservative-management group (P < .01). SF-36 evaluation improved in the operative group (P < .05).
  
  
  CONCLUSIONS
  Adrenalectomy can be more beneficial than conservative management in SCS and may achieve remission of laboratory hormonal abnormalities and improve BP, glycemic control, body mass index, and quality of life.
authors.affiliation: Minimally Invasive Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy. maurizio.iacobone@unipd.it
authors.forename: Maurizio
authors.initials: M
authors.lastname: Iacobone
authors.forename: Marilisa
authors.initials: M
authors.lastname: Citton
authors.forename: Giovanni
authors.initials: G
authors.lastname: Viel
authors.forename: Riccardo
authors.initials: R
authors.lastname: Boetto
authors.forename: Italo
authors.initials: I
authors.lastname: Bonadio
authors.forename: Isabella
authors.initials: I
authors.lastname: Mondi
authors.forename: Saveria
authors.initials: S
authors.lastname: Tropea
authors.forename: Donato
authors.initials: D
authors.lastname: Nitti
authors.forename: Gennaro
authors.initials: G
authors.lastname: Favia
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D000315:Adrenalectomy; D018246:Adrenocortical Adenoma / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D015992:Body Mass Index; D003480:Cushing Syndrome / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D033162:Incidental Findings; D008055:Lipids / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000503:physiopathology*; D008875:Middle Aged; D011788:Quality of Life
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D008055:Lipids