title: THERAPY OF ENDOCRINE DISEASE: Improvement of cardiovascular risk factors after adrenalectomy in patients with adrenal tumors and subclinical Cushing's syndrome: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Beneficial effects of adrenalectomy on cardiovascular risk factors in patients with subclinical Cushing's syndrome (SCS) are uncertain. We sought to conduct a systematic review and meta-analysis with the following objectives: (i) determine the effect of adrenalectomy compared with conservative management on cardiovascular risk factors in patients with SCS and (ii) compare the effect of adrenalectomy on cardiovascular risk factors in patients with SCS vs those with a nonfunctioning (NF) adrenal tumor.
  
  
  METHODS
  MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE, EMBASE and Cochrane Central Register of Controlled Trial were searched on 17 November 2015. Reviewers extracted data and assessed methodological quality in duplicate.
  
  
  RESULTS
  We included 26 studies reporting on 584 patients with SCS and 457 patients with NF adrenal tumors. Studies used different definitions of SCS. Patients with SCS undergoing adrenalectomy demonstrated an overall improvement in cardiovascular risk factors (61% for hypertension, 52% for diabetes mellitus, 45% for obesity and 24% for dyslipidemia). When compared with conservative management, patients with SCS undergoing adrenalectomy experienced improvement in hypertension (RR 11, 95% CI: 4.3-27.8) and diabetes mellitus (RR 3.9, 95% CI: 1.5-9.9), but not dyslipidemia (RR 2.6, 95% CI: 0.97-7.2) or obesity (RR 3.4, 95% CI: 0.95-12). Patients with NF adrenal tumors experienced improvement in hypertension (21/54 patients); however, insufficient data exist for comparison to patients with SCS.
  
  
  CONCLUSIONS
  Available low-to-moderate-quality evidence from heterogeneous studies suggests a beneficial effect of adrenalectomy on cardiovascular risk factors in patients with SCS overall and compared with conservative management.
authors.affiliation: Division of EndocrinologyDiabetes, Metabolism and Nutrition Bancos.Irina@mayo.edu.
authors.forename: Irina
authors.initials: I
authors.lastname: Bancos
authors.affiliation: Evidence-based Practice CenterMayo Clinic, Rochester, Minnesota, USA.
authors.forename: Fares
authors.initials: F
authors.lastname: Alahdab
authors.affiliation: St Vincent's University Hospital and University College DublinDublin, Ireland.
authors.forename: Rachel K
authors.initials: RK
authors.lastname: Crowley
authors.affiliation: Institute of Metabolism and Systems ResearchUniversity of Birmingham, Birmingham, UK.|Centre for EndocrinologyDiabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.
authors.forename: Vasileios
authors.initials: V
authors.lastname: Chortis
authors.affiliation: Division of EndocrinologyDiabetes, Metabolism and Nutrition.
authors.forename: Danae A
authors.initials: DA
authors.lastname: Delivanis
authors.affiliation: Division of EndocrinologyDiabetes, Metabolism and Nutrition.
authors.forename: Dana
authors.initials: D
authors.lastname: Erickson
authors.affiliation: Division of EndocrinologyDiabetes, Metabolism and Nutrition.
authors.forename: Neena
authors.initials: N
authors.lastname: Natt
authors.affiliation: Internal Medicine 1Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Terzolo
authors.affiliation: Institute of Metabolism and Systems ResearchUniversity of Birmingham, Birmingham, UK.|Centre for EndocrinologyDiabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.
authors.forename: Wiebke
authors.initials: W
authors.lastname: Arlt
authors.affiliation: Division of EndocrinologyDiabetes, Metabolism and Nutrition.
authors.forename: William F
authors.initials: WF
authors.lastname: Young
authors.affiliation: Evidence-based Practice CenterMayo Clinic, Rochester, Minnesota, USA.
authors.forename: M Hassan
authors.initials: MH
authors.lastname: Murad
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D000315:Adrenalectomy / Q000639:trends*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D003480:Cushing Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D012307:Risk Factors