• Annals of surgery · Jun 2024

    Randomized Controlled Trial Multicenter Study

    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.

    • Jung-Min Koh, Keeho Song, Mi Kyung Kwak, Sunghwan Suh, Beom-Jun Kim, Tae-Yon Sung, Jun Hyuk Hong, Byong Chang Jeong, Jae Hyeon Kim, and Seung Hun Lee.
    • Department of Medicine, Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
    • Ann. Surg. 2024 Jun 1; 279 (6): 945952945-952.

    ObjectiveTo assess the metabolic effects of adrenalectomy in patients with mild autonomous cortisol secretion (MACS).BackgroundDespite retrospective studies showing the association of adrenalectomy for MACS with beneficial metabolic effects, there have been only 2 randomized prospective studies with some limitations to date.MethodsA prospective, multicenter study randomized 132 patients with adrenal incidentaloma without any features of Cushing syndrome but with serum cortisol >50 nmol/L after a 1 mg overnight dexamethasone suppression test into an adrenalectomy group (n = 66) or control group (n = 66). The primary outcomes were changes in body weight, glucose, and blood pressure (BP).ResultsAmong 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 with 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% CI = 2.09-51.52, P = 0.004], body mass index (OR = 1.39, 95% CI = 1.08-1.79, P = 0.010), and cortisol after a 1 mg overnight dexamethasone suppression test 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.Conclusionsadrenalectomy improved weight, glucose, and BP control in patients with MACS.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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