Adrenalectomy Improves Body Weight, Glucose, and Blood Pressure Control in Patients with Mild Autonomous Cortisol Secretion: Results of an RCT by the Co-work of Adrenal Research (COAR) Study.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
21 Dec 2023
21 Dec 2023
Historique:
medline:
21
12
2023
pubmed:
21
12
2023
entrez:
21
12
2023
Statut:
aheadofprint
Résumé
To assess the metabolic effects of adrenalectomy in patients with mild autonomous cortisol secretion (MACS). Despite retrospective studies showing the association of adrenalectomy for MACS with beneficial metabolic effects, there have been only two randomized prospective studies with some limitations to date. A prospective, multicenter study randomized 132 patients with adrenal incidentaloma without any features of Cushing's syndrome but with serum cortisol>50 nmol/L after a 1 mg overnight dexamethasone suppression test (F-1mgODST) into an adrenalectomy group (n=66) or control group (n=66). The primary outcomes were changes in body weight, glucose, and blood pressure (BP). Among the 118 participants who completed the study with a median follow-up duration of 48 months (range: 3-66), the adrenalectomy group (n=46) exhibited a significantly higher frequency of improved weight control, glucose control, and BP control (32.6%, 45.7%, and 45.7%, respectively) compared to the control group (n=46; 6.5%, P=0.002; 15.2%, P=0.002; and 23.9%, P=0.029, respectively) after matching for age and sex. Adrenalectomy (odds ratio [OR]=10.38, 95% confidence interval [95% CI]=2.09-51.52, P=0.004), body mass index (OR=1.39, 95% CI=1.08-1.79, P=0.010), and F-1mgODST levels (OR=92.21, 95% CI=5.30-1604.07, P=0.002) were identified as independent factors associated with improved weight control. Adrenalectomy (OR=5.30, 95% CI=1.63-17.25, P=0.006) and diabetes (OR=8.05, 95% CI=2.34-27.65, P=0.001) were independently associated with improved glucose control. Adrenalectomy (OR=2.27, 95% CI=0.87-5.94, P=0.095) and hypertension (OR=10.77, 95% CI=3.65-31.81, P<0.001) demonstrated associations with improved BP control. Adrenalectomy improved weight, glucose, and BP control in patients with MACS.
Sections du résumé
OBJECTIVE
OBJECTIVE
To assess the metabolic effects of adrenalectomy in patients with mild autonomous cortisol secretion (MACS).
BACKGROUND
BACKGROUND
Despite retrospective studies showing the association of adrenalectomy for MACS with beneficial metabolic effects, there have been only two randomized prospective studies with some limitations to date.
METHODS
METHODS
A prospective, multicenter study randomized 132 patients with adrenal incidentaloma without any features of Cushing's syndrome but with serum cortisol>50 nmol/L after a 1 mg overnight dexamethasone suppression test (F-1mgODST) into an adrenalectomy group (n=66) or control group (n=66). The primary outcomes were changes in body weight, glucose, and blood pressure (BP).
RESULTS
RESULTS
Among the 118 participants who completed the study with a median follow-up duration of 48 months (range: 3-66), the adrenalectomy group (n=46) exhibited a significantly higher frequency of improved weight control, glucose control, and BP control (32.6%, 45.7%, and 45.7%, respectively) compared to the control group (n=46; 6.5%, P=0.002; 15.2%, P=0.002; and 23.9%, P=0.029, respectively) after matching for age and sex. Adrenalectomy (odds ratio [OR]=10.38, 95% confidence interval [95% CI]=2.09-51.52, P=0.004), body mass index (OR=1.39, 95% CI=1.08-1.79, P=0.010), and F-1mgODST levels (OR=92.21, 95% CI=5.30-1604.07, P=0.002) were identified as independent factors associated with improved weight control. Adrenalectomy (OR=5.30, 95% CI=1.63-17.25, P=0.006) and diabetes (OR=8.05, 95% CI=2.34-27.65, P=0.001) were independently associated with improved glucose control. Adrenalectomy (OR=2.27, 95% CI=0.87-5.94, P=0.095) and hypertension (OR=10.77, 95% CI=3.65-31.81, P<0.001) demonstrated associations with improved BP control.
CONCLUSIONS
CONCLUSIONS
Adrenalectomy improved weight, glucose, and BP control in patients with MACS.
Identifiants
pubmed: 38126763
doi: 10.1097/SLA.0000000000006183
pii: 00000658-990000000-00731
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflict of interest disclosures: All authors state that they have no conflicts of interest.