Adrenalectomy Improves Blood Pressure and Metabolic Control in Patients With Possible Autonomous Cortisol Secretion: Results of a RCT
ObjectiveThe best approach to patients with adrenal incidentaloma (AI) and possible autonomous cortisol secretion (PACS) is debated. The aim of this study was to assess the metabolic effect of adrenalectomy in AI patients with PACS in relation to cortisol secretion parameters, peripheral activation,...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-06-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2022.898084/full |
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| author | Valentina Morelli Sofia Frigerio Sofia Frigerio Carmen Aresta Elena Passeri Flavia Pugliese Massimilano Copetti Anna Maria Barbieri Anna Maria Barbieri Silvia Fustinoni Silvia Fustinoni Elisa Polledri Sabrina Corbetta Sabrina Corbetta Maura Arosio Maura Arosio Alfredo Scillitani Iacopo Chiodini Iacopo Chiodini |
| author_facet | Valentina Morelli Sofia Frigerio Sofia Frigerio Carmen Aresta Elena Passeri Flavia Pugliese Massimilano Copetti Anna Maria Barbieri Anna Maria Barbieri Silvia Fustinoni Silvia Fustinoni Elisa Polledri Sabrina Corbetta Sabrina Corbetta Maura Arosio Maura Arosio Alfredo Scillitani Iacopo Chiodini Iacopo Chiodini |
| author_sort | Valentina Morelli |
| collection | DOAJ |
| description | ObjectiveThe best approach to patients with adrenal incidentaloma (AI) and possible autonomous cortisol secretion (PACS) is debated. The aim of this study was to assess the metabolic effect of adrenalectomy in AI patients with PACS in relation to cortisol secretion parameters, peripheral activation, and glucocorticoid sensitivity.DesignThis is a multicenter randomized study (NCT number: NCT04860180).MethodsSixty-two AI outpatients (40–75 years) with AI >1 cm and cortisol after overnight dexamethasone suppression test (F-1mgDST) between 50 and 138 nmol/L were randomized to adrenalectomy (Arm A) or a conservative approach (Arm B). Fifty-five patients completed the 6-month follow-up, 25 patients in Arm A (17 female patients, aged 62.5 ± 10.4 years) and 30 patients in Arm B (24 female patients, 66.1 ± 9.1 years). Plasma adrenocorticotroph hormone (ACTH), 24-h urinary free cortisol, 24-h urinary free cortisone, F-1mgDST, glucose, lipids, glycated hemoglobin (HbA1c) levels, blood pressure (BP), body weight, and treatment variations were assessed. The 24-h urinary free cortisol/cortisone ratio (an 11-beta hydroxysteroid dehydrogenase type 2 activity marker), BclI, and the N363S variants of glucocorticoid receptor (GR) polymorphisms were also evaluated.ResultsBP control improved in 68% and 13% of the subjects in Arm A and Arm B, respectively (p = 0.001), and the glycometabolic control improved in 28% and 3.3% of the subjects in Arm A and Arm B patients, respectively (p = 0.02). Arm A subjects more rarely showed the BP and/or glycometabolic control worsening than Arm B patients (12% and 40%, respectively, p = 0.03). The surgical approach was independently associated with BP amelioration (OR 3.0, 95% CI 3.8–108.3, p < 0.001) but not with age, F-1mgDST levels, BMI, and hypertension and diabetes mellitus presence at baseline. The 24-h urinary free cortisol/cortisone ratio and the presence of sensitizing GR polymorphisms were not associated with the surgical outcome. The receiver operating characteristic (ROC) curve analysis showed that the BP control amelioration was associated with F-1mgDST [area under the curve (AUC), 0.82 ± 0.09 p = 0.012]. The F-1mgDST cutoff with the best compromise in predicting the BP amelioration was set at 75 nmol/L (sensitivity 77%, specificity 75%).ConclusionsAI patients with PACS benefit from surgery in terms of BP and glycometabolic control. |
| first_indexed | 2024-04-12T17:40:26Z |
| format | Article |
| id | doaj.art-7ef1b3103848418eaca97a26a36ef349 |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-04-12T17:40:26Z |
| publishDate | 2022-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-7ef1b3103848418eaca97a26a36ef3492022-12-22T03:22:49ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922022-06-011310.3389/fendo.2022.898084898084Adrenalectomy Improves Blood Pressure and Metabolic Control in Patients With Possible Autonomous Cortisol Secretion: Results of a RCTValentina Morelli0Sofia Frigerio1Sofia Frigerio2Carmen Aresta3Elena Passeri4Flavia Pugliese5Massimilano Copetti6Anna Maria Barbieri7Anna Maria Barbieri8Silvia Fustinoni9Silvia Fustinoni10Elisa Polledri11Sabrina Corbetta12Sabrina Corbetta13Maura Arosio14Maura Arosio15Alfredo Scillitani16Iacopo Chiodini17Iacopo Chiodini18Unit for Bone Metabolism Diseases and Diabetes, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, ItalyUnit of Endocrinology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Cà Granda-Ospedale Maggiore Policlinico, Milan, ItalyDepartment of Clinical Sciences and Community Health, University of Milan, Milan, ItalyUnit for Bone Metabolism Diseases and Diabetes, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, ItalyEndocrinology and Diabetology Service, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Galeazzi, Milan, ItalyUnità Operativa di Endocrinologia Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)—”Casa Sollievo della Sofferenza”—Hospital, San Giovanni Rotondo, Foggia, ItalyUnit of Biostatistics Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)—”Casa Sollievo della Sofferenza”—Hospital, San Giovanni Rotondo, Foggia, ItalyUnit of Endocrinology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Cà Granda-Ospedale Maggiore Policlinico, Milan, ItalyDepartment of Clinical Sciences and Community Health, University of Milan, Milan, ItalyDepartment of Clinical Sciences and Community Health, University of Milan, Milan, ItalyLab Toxicology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Cà Granda-Ospedale Maggiore Policlinico, Milan, ItalyDepartment of Clinical Sciences and Community Health, University of Milan, Milan, ItalyEndocrinology and Diabetology Service, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Galeazzi, Milan, ItalyDepartment of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, ItalyUnit of Endocrinology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Cà Granda-Ospedale Maggiore Policlinico, Milan, ItalyDepartment of Clinical Sciences and Community Health, University of Milan, Milan, ItalyUnità Operativa di Endocrinologia Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)—”Casa Sollievo della Sofferenza”—Hospital, San Giovanni Rotondo, Foggia, ItalyUnit for Bone Metabolism Diseases and Diabetes, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, ItalyDepartment of Medical Biotechnology and Translational Medicine, University of Milan, Milan, ItalyObjectiveThe best approach to patients with adrenal incidentaloma (AI) and possible autonomous cortisol secretion (PACS) is debated. The aim of this study was to assess the metabolic effect of adrenalectomy in AI patients with PACS in relation to cortisol secretion parameters, peripheral activation, and glucocorticoid sensitivity.DesignThis is a multicenter randomized study (NCT number: NCT04860180).MethodsSixty-two AI outpatients (40–75 years) with AI >1 cm and cortisol after overnight dexamethasone suppression test (F-1mgDST) between 50 and 138 nmol/L were randomized to adrenalectomy (Arm A) or a conservative approach (Arm B). Fifty-five patients completed the 6-month follow-up, 25 patients in Arm A (17 female patients, aged 62.5 ± 10.4 years) and 30 patients in Arm B (24 female patients, 66.1 ± 9.1 years). Plasma adrenocorticotroph hormone (ACTH), 24-h urinary free cortisol, 24-h urinary free cortisone, F-1mgDST, glucose, lipids, glycated hemoglobin (HbA1c) levels, blood pressure (BP), body weight, and treatment variations were assessed. The 24-h urinary free cortisol/cortisone ratio (an 11-beta hydroxysteroid dehydrogenase type 2 activity marker), BclI, and the N363S variants of glucocorticoid receptor (GR) polymorphisms were also evaluated.ResultsBP control improved in 68% and 13% of the subjects in Arm A and Arm B, respectively (p = 0.001), and the glycometabolic control improved in 28% and 3.3% of the subjects in Arm A and Arm B patients, respectively (p = 0.02). Arm A subjects more rarely showed the BP and/or glycometabolic control worsening than Arm B patients (12% and 40%, respectively, p = 0.03). The surgical approach was independently associated with BP amelioration (OR 3.0, 95% CI 3.8–108.3, p < 0.001) but not with age, F-1mgDST levels, BMI, and hypertension and diabetes mellitus presence at baseline. The 24-h urinary free cortisol/cortisone ratio and the presence of sensitizing GR polymorphisms were not associated with the surgical outcome. The receiver operating characteristic (ROC) curve analysis showed that the BP control amelioration was associated with F-1mgDST [area under the curve (AUC), 0.82 ± 0.09 p = 0.012]. The F-1mgDST cutoff with the best compromise in predicting the BP amelioration was set at 75 nmol/L (sensitivity 77%, specificity 75%).ConclusionsAI patients with PACS benefit from surgery in terms of BP and glycometabolic control.https://www.frontiersin.org/articles/10.3389/fendo.2022.898084/fulladrenal incidentalomahypercortisolismhypertensiondiabetesadrenalectomy |
| spellingShingle | Valentina Morelli Sofia Frigerio Sofia Frigerio Carmen Aresta Elena Passeri Flavia Pugliese Massimilano Copetti Anna Maria Barbieri Anna Maria Barbieri Silvia Fustinoni Silvia Fustinoni Elisa Polledri Sabrina Corbetta Sabrina Corbetta Maura Arosio Maura Arosio Alfredo Scillitani Iacopo Chiodini Iacopo Chiodini Adrenalectomy Improves Blood Pressure and Metabolic Control in Patients With Possible Autonomous Cortisol Secretion: Results of a RCT Frontiers in Endocrinology adrenal incidentaloma hypercortisolism hypertension diabetes adrenalectomy |
| title | Adrenalectomy Improves Blood Pressure and Metabolic Control in Patients With Possible Autonomous Cortisol Secretion: Results of a RCT |
| title_full | Adrenalectomy Improves Blood Pressure and Metabolic Control in Patients With Possible Autonomous Cortisol Secretion: Results of a RCT |
| title_fullStr | Adrenalectomy Improves Blood Pressure and Metabolic Control in Patients With Possible Autonomous Cortisol Secretion: Results of a RCT |
| title_full_unstemmed | Adrenalectomy Improves Blood Pressure and Metabolic Control in Patients With Possible Autonomous Cortisol Secretion: Results of a RCT |
| title_short | Adrenalectomy Improves Blood Pressure and Metabolic Control in Patients With Possible Autonomous Cortisol Secretion: Results of a RCT |
| title_sort | adrenalectomy improves blood pressure and metabolic control in patients with possible autonomous cortisol secretion results of a rct |
| topic | adrenal incidentaloma hypercortisolism hypertension diabetes adrenalectomy |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2022.898084/full |
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