Randomized trial studying metabolic outcomes and quality of life after adrenalectomy versus conservative management for mild autonomous cortisol secretion
Objective: Evaluate the impact of adrenalectomy on metabolic parameters and quality of life (QoL) in patients with mild autonomous cortisol secretion (MACS). Method: A multicenter prospective randomized clinical trial compared adrenalectomy with conservative management. Metabolic parameters and QoL...
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Bioscientifica
2025-07-01
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| Series: | Endocrine Connections |
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| Online Access: | https://ec.bioscientifica.com/view/journals/ec/14/7/EC-25-0361.xml |
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| author | Grethe Å Ueland Oskar Ragnarsson Anette Heie Albin Kjellbom Ola Lindgren Andreas Muth Fausto Palazzo Per L Poulsen Lars Rolighed Hrafnkell Baldur Thordarson Florian Wernig Anders Bergenfelz |
| author_facet | Grethe Å Ueland Oskar Ragnarsson Anette Heie Albin Kjellbom Ola Lindgren Andreas Muth Fausto Palazzo Per L Poulsen Lars Rolighed Hrafnkell Baldur Thordarson Florian Wernig Anders Bergenfelz |
| author_sort | Grethe Å Ueland |
| collection | DOAJ |
| description | Objective: Evaluate the impact of adrenalectomy on metabolic parameters and quality of life (QoL) in patients with mild autonomous cortisol secretion (MACS). Method: A multicenter prospective randomized clinical trial compared adrenalectomy with conservative management. Metabolic parameters and QoL were assessed at baseline and after 2 years. Results: Forty-three MACS patients with a single adrenal adenoma were randomized to either adrenalectomy (n = 21) or conservative management (n = 22). At baseline, 33 patients had hypertension, 13 had type 2 diabetes (T2D), 18 used statins, and nine patients had osteoporosis. After 2 years, normalization of cortisol levels post 1 mg dexamethasone suppression test was achieved in 19/21 adrenalectomy patients compared to 2/22 patients in the conservative group (P < 0.01). All adrenalectomy patients had a significant increase in ACTH and DHEA-S. Office blood pressure and daily defined doses of antihypertensives (DDD) improved in nine of 12 adrenalectomy patients versus four of 15 conservatively treated patients (P = 0.01). Using 24 h blood pressure and DDD, improvement rates were five of 11 in the adrenalectomy group and six of 15 in the conservative group (P = 0.78). Among patients without T2D, the 120 min glucose level during oral glucose tolerance test was lower in the adrenalectomy group (6.2 vs 7.3 mmol/L, P = 0.04), but within-group changes were not different (P = 0.76). There were no statistically significant differences in QoL between the two groups. Conclusion: Adrenalectomy showed trends toward improvement in office blood pressure and glucose metabolism in MACS, suggesting possible reduction in cardiovascular risk and metabolic complications. |
| format | Article |
| id | doaj-art-2cfecc6b60fe423dae7ac33b55838eea |
| institution | Kabale University |
| issn | 2049-3614 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Bioscientifica |
| record_format | Article |
| series | Endocrine Connections |
| spelling | doaj-art-2cfecc6b60fe423dae7ac33b55838eea2025-08-20T03:51:44ZengBioscientificaEndocrine Connections2049-36142025-07-0114710.1530/EC-25-03611Randomized trial studying metabolic outcomes and quality of life after adrenalectomy versus conservative management for mild autonomous cortisol secretionGrethe Å Ueland0Oskar Ragnarsson1Anette Heie2Albin Kjellbom3Ola Lindgren4Andreas Muth5Fausto Palazzo6Per L Poulsen7Lars Rolighed8Hrafnkell Baldur Thordarson9Florian Wernig10Anders Bergenfelz11Department of Medicine, Haukeland University Hospital, Bergen, NorwayDepartment of Endocrinology, Sahlgrenska University Hospital, Gothenburg, SwedenDepartments of Breast and Endocrine Surgery, Haukeland University Hospital, Bergen, NorwayLund University, Faculty of Medicine, Department of Clinical Sciences Lund, Lund, SwedenLund University, Faculty of Medicine, Department of Clinical Sciences Lund, Lund, SwedenDepartment of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenHammersmith Hospital, Imperial College Healthcare NHS Trust, London, UKSteno Diabetes Center Aarhus (SDCA), Aarhus University Hospital, Aarhus, DenmarkDepartment of Surgery and Department of Otorhinolaryngology, Aarhus University Hospital, Aarhus, DenmarkDepartment of Medicine, Haukeland University Hospital, Bergen, NorwayHammersmith Hospital, Imperial College Healthcare NHS Trust, London, UKLund University, Faculty of Medicine, Department of Clinical Sciences Lund, Lund, SwedenObjective: Evaluate the impact of adrenalectomy on metabolic parameters and quality of life (QoL) in patients with mild autonomous cortisol secretion (MACS). Method: A multicenter prospective randomized clinical trial compared adrenalectomy with conservative management. Metabolic parameters and QoL were assessed at baseline and after 2 years. Results: Forty-three MACS patients with a single adrenal adenoma were randomized to either adrenalectomy (n = 21) or conservative management (n = 22). At baseline, 33 patients had hypertension, 13 had type 2 diabetes (T2D), 18 used statins, and nine patients had osteoporosis. After 2 years, normalization of cortisol levels post 1 mg dexamethasone suppression test was achieved in 19/21 adrenalectomy patients compared to 2/22 patients in the conservative group (P < 0.01). All adrenalectomy patients had a significant increase in ACTH and DHEA-S. Office blood pressure and daily defined doses of antihypertensives (DDD) improved in nine of 12 adrenalectomy patients versus four of 15 conservatively treated patients (P = 0.01). Using 24 h blood pressure and DDD, improvement rates were five of 11 in the adrenalectomy group and six of 15 in the conservative group (P = 0.78). Among patients without T2D, the 120 min glucose level during oral glucose tolerance test was lower in the adrenalectomy group (6.2 vs 7.3 mmol/L, P = 0.04), but within-group changes were not different (P = 0.76). There were no statistically significant differences in QoL between the two groups. Conclusion: Adrenalectomy showed trends toward improvement in office blood pressure and glucose metabolism in MACS, suggesting possible reduction in cardiovascular risk and metabolic complications.https://ec.bioscientifica.com/view/journals/ec/14/7/EC-25-0361.xmladrenal incidentalomasmild autonomous cortisol secretionmacsadrenalectomymetabolic consequences |
| spellingShingle | Grethe Å Ueland Oskar Ragnarsson Anette Heie Albin Kjellbom Ola Lindgren Andreas Muth Fausto Palazzo Per L Poulsen Lars Rolighed Hrafnkell Baldur Thordarson Florian Wernig Anders Bergenfelz Randomized trial studying metabolic outcomes and quality of life after adrenalectomy versus conservative management for mild autonomous cortisol secretion Endocrine Connections adrenal incidentalomas mild autonomous cortisol secretion macs adrenalectomy metabolic consequences |
| title | Randomized trial studying metabolic outcomes and quality of life after adrenalectomy versus conservative management for mild autonomous cortisol secretion |
| title_full | Randomized trial studying metabolic outcomes and quality of life after adrenalectomy versus conservative management for mild autonomous cortisol secretion |
| title_fullStr | Randomized trial studying metabolic outcomes and quality of life after adrenalectomy versus conservative management for mild autonomous cortisol secretion |
| title_full_unstemmed | Randomized trial studying metabolic outcomes and quality of life after adrenalectomy versus conservative management for mild autonomous cortisol secretion |
| title_short | Randomized trial studying metabolic outcomes and quality of life after adrenalectomy versus conservative management for mild autonomous cortisol secretion |
| title_sort | randomized trial studying metabolic outcomes and quality of life after adrenalectomy versus conservative management for mild autonomous cortisol secretion |
| topic | adrenal incidentalomas mild autonomous cortisol secretion macs adrenalectomy metabolic consequences |
| url | https://ec.bioscientifica.com/view/journals/ec/14/7/EC-25-0361.xml |
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