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

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Abstract

Purpose

To compare the evolution of the cardiometabolic parameters in patients with nonfunctioning adrenal incidentalomas (NFAI) and autonomous cortisol secretion (ACS) who underwent adrenalectomy and those who were conservatively managed.

Methods

A retrospective study of all patients with NFAI and ACS submitted to surgery or in follow-up in our center between January 2011-October 2020. NFAI was defined as an adrenal incidentaloma with cortisol post-dexamethasone suppression test (DST) ≤ 50 nmol/L and ACS as values >50 nmol/L without specific clinical signs of overt Cushing´s syndrome.

Results

A total of 486 patients with NFAI (16 in the surgical group and 470 in the control group) and 259 with ACS (42 in the surgical group and 217 in the control group) were included. At baseline, patients with ACS were older than those with NFAI (P = 0.010). After adjusting by age, patients with ACS had a higher prevalence of hypertension (adjusted OR = 1.9 [1.36–2.60]) and higher levels of fasting plasma glucose and HbA1c (adjusted β = 6.9 [2.05–11.83] and adjusted β = 0.4 [0.12–0.63]) than NFAI. During follow-up, ACS patients who underwent adrenalectomy had a greater decrease in glucose levels (−16.6 ± 45.07 vs. −1.0 ± 26.92 mg/dL, P = 0.035) and in triglycerides (−20.21 ± 55.97 vs. 1.3 ± 59.23 mg/dL, P = 0.029) than ACS patients conservatively managed. 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 = 0.009).

Conclusion

The benefits of adrenalectomy in the cardiometabolic profile in adrenal incidentalomas are not limited only to the group of patients with ACS, an improvement in blood pressure control is also observed in NFAI patients after surgery.

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Funding

SENDIMAD: BECA SENDIMAD de Ayuda a la Investigación en Endocrinología, Nutrición y Diabetes 2019 IRYCIS: Convocatoria intramural de ayudas a proyectos de investigación de investigadores noveles, investigadores clínicos asociados y/o grupos emergentes del Hospital Universitario Ramón y Cajal 2019.

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Authors and Affiliations

  1. Endocrinology & Nutrition Department, Ramón y Cajal University Hospital, Madrid, Spain

    Marta Araujo-Castro, María Noelia Sánchez Ramírez, Eider Pascual-Corrrales & María Fernández-Argüeso

  2. Ramón y Cajal Biomedical Research Institute (IRYCIS), Madrid, Spain

    Marta Araujo-Castro

  3. Medicine Department, Alcalá University, Madrid, Spain

    Marta Araujo-Castro

  4. Urology Department, Ramón y Cajal University Hospital, Madrid, Spain

    César Mínguez Ojeda & Victoria Gómez Dos Santos

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  1. Marta Araujo-Castro
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Correspondence to Marta Araujo-Castro.

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The study was approved by the Ethics Committee of Hospital Universitario Ramón y Cajal on 5TH August 2020 (Approval date: 28th of July 2020, Code: 395.

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Due to the retrospective nature of the study, the Ethical Committee has approved the need of informed consent only in those patients who continued in follow-up in our center.

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Araujo-Castro, M., Mínguez Ojeda, C., Sánchez Ramírez, M.N. et al. Adrenalectomy improves blood pressure control in nonfunctioning adrenal incidentalomas and glycemic and lipid control in patients with autonomous cortisol secretion. Endocrine 78, 142–150 (2022). https://doi.org/10.1007/s12020-022-03120-w

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