Adrenalectomy improves blood pressure control in nonfunctioning adrenal incidentalomas and glycemic and lipid control in patients with autonomous cortisol secretion

Araujo‐Castro, Marta; Ojeda, C. Mínguez; Ramírez, María Noelia Sánchez; Santos, V. Gómez Dos; Pascual-Corrrales, Eider; Fernández-Argüeso, María

doi:10.1007/s12020-022-03120-w

Cited by 13 publications

(8 citation statements)

References 54 publications

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“…Our meta-analysis revealed that SBP, DBP, and osteoporosis management of adrenalectomy were significantly better than conservative therapy. Additionally, in some included studies, the benefits of adrenalectomy in the control of dyslipidemia and obesity were reported but they were not significantly different in our subgroup analysis ( 28 , 35 , 39 , 40 , 42 , 43 , 46 – 48 ). It’s important to take into account that weight loss after abdominal surgery may influence parameters such as lipid profile and blood glucose levels ( 77 , 78 ).…”

Section: Discussionmentioning

confidence: 59%

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Comparison of adrenalectomy with conservative treatment on mild autonomous cortisol secretion: a systematic review and meta-analysis

Khadembashiri,

Mohseni,

Harandi

et al. 2024

Front. Endocrinol.

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ObjectiveThis systematic review and meta-analysis was conducted to compare the benefits of adrenalectomy and conservative treatment for comorbidities associated with mild autonomous cortisol secretion (MACS) in patients diagnosed with MACS.BackgroundMACS is the most common benign hormone-secreting functional adrenal incidentaloma. Overproduction of cortisol is observed in MACS patients, resulting in a variety of long-term health issues, including arterial hypertension (HTN), diabetes mellitus (DM), dyslipidemia, obesity, and osteoporosis; however, the classic clinical manifestations of Cushing’s syndrome (CS) are not present.MethodsA systematic search was conducted using MEDLINE, Embase, Web of Sciences, and Scopus databases on December, 2023. Two reviewers independently extracted data and assessed the quality of the included articles. A meta-analysis was performed to compare the beneficial effects of adrenalectomy versus conservative management for MACS-related comorbidities.ResultsFifteen articles were included in this study, which evaluated 933 MACS patients (384 Adrenalectomy and 501 Conservative treatment, and 48 excluded due to incomplete follow-up duration). MACS diagnosis criteria were different among the included articles. All studies, however, stated that there must be no overt CS symptoms. Meta-analysis demonstrates the overall advantage of adrenalectomy over conservative treatment for MACS-related comorbidities (Cohen’s d = -0.49, 95% CI [-0.64, -0.34], p = 0.00). Subgroup analysis indicated that the systolic blood pressure (pooled effect size = -0.81, 95% CI [-1.19, -0.42], p = 0.03), diastolic blood pressure (pooled effect size = -0.63, 95% CI [-1.05, -0.21], p = 0.01), and BMD (pooled effect size = -0.40, 95% CI [-0.73, -0.07], p = 0.02) were significantly in favor of adrenalectomy group rather than conservative treatment but no significant differences between the two treatment groups in other MACS-related comorbidities were reported.ConclusionDespite the limited and diverse data, this study demonstrates the advantage of adrenalectomy over conservative treatment for MACS-related comorbidities.

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Section: Discussionmentioning

confidence: 59%

“…In the studies conducted by Wang et al. ( 42 ) Araujo-Castro et al., adrenalectomy exhibited a significant improvement in TG levels compared to conservative treatment. Furthermore, three studies documented a significant improvement in HDL levels following adrenalectomy compared to the levels observed before the procedure.…”

Section: Resultsmentioning

confidence: 96%

Comparison of adrenalectomy with conservative treatment on mild autonomous cortisol secretion: a systematic review and meta-analysis

Khadembashiri,

Mohseni,

Harandi

et al. 2024

Front. Endocrinol.

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“…Recently, Araujo-Castro et al 26 The fact is that the management of NFAI is still conservative according to the most recent guidelines. 1 Nevertheless, we believe that if NFAI might increase cardiometabolic risk in a way that we cannot easily differentiate from the ACS group, we should probably be more assertive in the management of NFAI, and we might consider NFAI as additional risk condition for CVD.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Araujo‐Castro et al 26 compared cardiometabolic parameters in patients with NFAI and ACS who underwent adrenalectomy and those who were conservatively managed and found that NFAI patients who underwent surgery experienced an improvement in systolic blood pressure compared to NFAI of the conservative group (−11.1 ± 15.94 vs. 1.0 ± 17.54 mmHg, p = .009).…”

Section: Discussionmentioning

confidence: 99%

Adrenal incidentaloma: Do patients with apparently nonfunctioning mass or autonomous cortisol secretion have similar or different clinical and metabolic features?

Rebelo

Costa

Junqueira

et al. 2023

Clinical Endocrinology

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Objective Although there is growing evidence associating nonfunctioning adrenal incidentalomas (NFAI) with cardiovascular risk factors, there are limited data whether NFAI and autonomous cortisol secretion (ACS) groups have similar or different clinical and metabolic features. The aim of this study is to compare cardiometabolic clinic parameters among patients with ACS and NFAI, as well as controls. Design Cross‐sectional study. Patients Eighty nine NFAI, 58 ACS and 64 controls were evaluated. Measurements Diagnosis of NFAI (1 mg dexamethasone suppression test [1 mg‐DST] ≤50 nmol/L [≤1.8 μg/dl]) and ACS (1 mg‐DST > 50 nmol/L [> 1.8 μg/dl]) was established according to current guidelines. The control group was selected based on a normal adrenal imaging exam. Results There were no differences between groups regarding age, gender, ethnicity, menopause or body mass index. Patients with adrenal incidentaloma presented higher frequency of hypertension (74.1 vs. 57.8%; p = .02), resistant hypertension (45.4 vs. 9.4%; p < .001), dyslipidemia (80.1 vs. 63.9%; p = .01), as well as metabolic syndrome (84.2 vs. 61.7%; p = .001) compared to the controls, respectively. NFAI and ACS patients presented similar frequency of arterial hypertension (70.8 vs. 79.3%) and resistant hypertension (41.3 vs. 51.1%), dyslipidemia (79.3 vs. 81.5%) and metabolic syndrome (83.3 vs. 85.7%); also, levels of HbA1c were similar between the groups. Binary logistic regression showed that NFAI (p = .004) and ACS (p = .001) were independent predictors for resistant hypertension (p = .003); also, ACS was an independent predictor for metabolic syndrome (p = .04). Conclusions NFAI and ACS presented a higher frequency of cardiometabolic morbidities in comparison with individuals with normal adrenal glands. Additionally, we demonstrated that both ACS and NFAI groups have similar cardiometabolic conditions.

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“…Overweight was de ned as BMI between 25.0 and 30.0 kg/m 2 . Cardiovascular disease, type 2 diabetes, hypertension and dyslipidemia were de ned as we previously described [7].…”

Section: Study Populationmentioning

confidence: 99%

Influence of obesity and overweight in surgical outcomes of adrenalectomy for primary adrenal disease: A cohort study of 146 cases

Mínguez Ojeda,

Gómez Dos Santos,

Lorca

et al. 2023

Endocrinología, Diabetes y Nutrición

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Adrenalectomy improves blood pressure control in nonfunctioning adrenal incidentalomas and glycemic and lipid control in patients with autonomous cortisol secretion

Cited by 13 publications

References 54 publications

Comparison of adrenalectomy with conservative treatment on mild autonomous cortisol secretion: a systematic review and meta-analysis

Comparison of adrenalectomy with conservative treatment on mild autonomous cortisol secretion: a systematic review and meta-analysis

Adrenal incidentaloma: Do patients with apparently nonfunctioning mass or autonomous cortisol secretion have similar or different clinical and metabolic features?

Influence of obesity and overweight in surgical outcomes of adrenalectomy for primary adrenal disease: A cohort study of 146 cases

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