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


METHODS
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.
I
I
Perogamvros
Department of EndocrinologyDiabetes and Metabolism, Evangelismos Hospital, 106 76 Athens, GreeceEndocrine UnitSecond Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Center, Attiko University Hospital, 12462 Athens, Greece.
D A
DA
Vassiliadi
O
O
Karapanou
E
E
Botoula
M
M
Tzanela
S
S
Tsagarakis
D000306:Adrenal Cortex Neoplasms / Q000378:metabolism / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000453:epidemiology / Q000378:metabolism / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D018246:Adrenocortical Adenoma / Q000453:epidemiology / Q000378:metabolism / Q000601:surgery*; D000368:Aged; D058070:Asymptomatic Diseases; D016022:Case-Control Studies; D015331:Cohort Studies; D015897:Comorbidity; D003480:Cushing Syndrome / Q000453:epidemiology / Q000378:metabolism / Q000601:surgery*; D003920:Diabetes Mellitus / Q000453:epidemiology; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D018149:Glucose Intolerance / Q000453:epidemiology; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000652:urine; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome
D006854:Hydrocortisone