Biochemical and clinical benefits of unilateral adrenalectomy in patients with subclinical hypercortisolism and bilateral adrenal incidentalomasCitation formats

  • External authors:
  • D A Vassiliadi
  • O Karapanou
  • E Botoula
  • M Tzanela
  • S Tsagarakis

Standard

Biochemical and clinical benefits of unilateral adrenalectomy in patients with subclinical hypercortisolism and bilateral adrenal incidentalomas. / Perogamvros, I; Vassiliadi, D A; Karapanou, O; Botoula, E; Tzanela, M; Tsagarakis, S.

In: European Journal of Endocrinology, Vol. 173, No. 6, 12.2015, p. 719-25.

Research output: Contribution to journalArticlepeer-review

Harvard

Perogamvros, I, Vassiliadi, DA, Karapanou, O, Botoula, E, Tzanela, M & Tsagarakis, S 2015, 'Biochemical and clinical benefits of unilateral adrenalectomy in patients with subclinical hypercortisolism and bilateral adrenal incidentalomas', European Journal of Endocrinology, vol. 173, no. 6, pp. 719-25. https://doi.org/10.1530/EJE-15-0566

APA

Perogamvros, I., Vassiliadi, D. A., Karapanou, O., Botoula, E., Tzanela, M., & Tsagarakis, S. (2015). Biochemical and clinical benefits of unilateral adrenalectomy in patients with subclinical hypercortisolism and bilateral adrenal incidentalomas. European Journal of Endocrinology, 173(6), 719-25. https://doi.org/10.1530/EJE-15-0566

Vancouver

Author

Perogamvros, I ; Vassiliadi, D A ; Karapanou, O ; Botoula, E ; Tzanela, M ; Tsagarakis, S. / Biochemical and clinical benefits of unilateral adrenalectomy in patients with subclinical hypercortisolism and bilateral adrenal incidentalomas. In: European Journal of Endocrinology. 2015 ; Vol. 173, No. 6. pp. 719-25.

Bibtex

@article{849bcbff4a234529b2a2bf88faef785d,
title = "Biochemical and clinical benefits of unilateral adrenalectomy in patients with subclinical hypercortisolism and bilateral adrenal incidentalomas",
abstract = "OBJECTIVE: The treatment of subclinical hypercortisolism in patients with bilateral adrenal incidentalomas (AI) is debatable. We aimed to compare the biochemical and clinical outcome of unilateral adrenalectomy vs a conservative approach in these patients.DESIGN: Retrospective study.METHODS: The study included 33 patients with bilateral AI; 14 patients underwent unilateral adrenalectomy of the largest lesion (surgical group), whereas 19 patients were followed up (follow-up group). At baseline and at each follow-up visit, we measured 0800 h plasma ACTH, midnight serum cortisol (MSF), 24-h urinary-free cortisol (UFC) and serum cortisol following a standard 2-day low-dose-dexamethasone-suppression test (LDDST). We evaluated the following comorbidities: arterial hypertension, impaired glucose tolerance or diabetes mellitus, dyslipidemia and osteoporosis.RESULTS: Baseline demographic, clinical characteristics and the duration of follow-up (53.9±21.3 vs 51.8±20.1 months, for the surgical vs the follow-up group) were similar between groups. At the last follow-up visit the surgical group had a significant reduction in post-LDDST cortisol (2.4±1.6 vs 6.7±3.9 μg/dl, P=0.002), MSF (4.3±2 vs 8.8±4.6 μg/dl, P=0.006) and 24-h UFC (50.1±21.1 vs 117.9±42.4 μg/24 h, P=0.0007) and a significant rise in mean±s.d. morning plasma ACTH levels (22.2±9.6 vs 6.9±4.8 pg/ml, P=0.002). Improvement in co-morbidities was seen only in the surgical group, whereas no changes were noted in the follow-up group.CONCLUSIONS: Our early results show that removal of the largest lesion offers significant improvement both to cortisol excess and its metabolic consequences, without the debilitating effects of bilateral adrenalectomy. A larger number of patients, as well as a longer follow-up, are required before drawing solid conclusions.",
keywords = "Adrenal Cortex Neoplasms/metabolism, Adrenal Gland Neoplasms/epidemiology, Adrenalectomy/methods, Adrenocortical Adenoma/epidemiology, Aged, Asymptomatic Diseases, Case-Control Studies, Cohort Studies, Comorbidity, Cushing Syndrome/epidemiology, Diabetes Mellitus/epidemiology, Dyslipidemias/epidemiology, Female, Glucose Intolerance/epidemiology, Humans, Hydrocortisone/blood, Hypertension/epidemiology, Male, Middle Aged, Osteoporosis/epidemiology, Retrospective Studies, Treatment Outcome",
author = "I Perogamvros and Vassiliadi, {D A} and O Karapanou and E Botoula and M Tzanela and S Tsagarakis",
note = "{\textcopyright} 2015 European Society of Endocrinology.",
year = "2015",
month = dec,
doi = "10.1530/EJE-15-0566",
language = "English",
volume = "173",
pages = "719--25",
journal = "European Journal of Endocrinology",
issn = "0804-4643",
publisher = "BioScientifica",
number = "6",

}

RIS

TY - JOUR

T1 - Biochemical and clinical benefits of unilateral adrenalectomy in patients with subclinical hypercortisolism and bilateral adrenal incidentalomas

AU - Perogamvros, I

AU - Vassiliadi, D A

AU - Karapanou, O

AU - Botoula, E

AU - Tzanela, M

AU - Tsagarakis, S

N1 - © 2015 European Society of Endocrinology.

PY - 2015/12

Y1 - 2015/12

N2 - OBJECTIVE: The treatment of subclinical hypercortisolism in patients with bilateral adrenal incidentalomas (AI) is debatable. We aimed to compare the biochemical and clinical outcome of unilateral adrenalectomy vs a conservative approach in these patients.DESIGN: Retrospective study.METHODS: The study included 33 patients with bilateral AI; 14 patients underwent unilateral adrenalectomy of the largest lesion (surgical group), whereas 19 patients were followed up (follow-up group). At baseline and at each follow-up visit, we measured 0800 h plasma ACTH, midnight serum cortisol (MSF), 24-h urinary-free cortisol (UFC) and serum cortisol following a standard 2-day low-dose-dexamethasone-suppression test (LDDST). We evaluated the following comorbidities: arterial hypertension, impaired glucose tolerance or diabetes mellitus, dyslipidemia and osteoporosis.RESULTS: Baseline demographic, clinical characteristics and the duration of follow-up (53.9±21.3 vs 51.8±20.1 months, for the surgical vs the follow-up group) were similar between groups. At the last follow-up visit the surgical group had a significant reduction in post-LDDST cortisol (2.4±1.6 vs 6.7±3.9 μg/dl, P=0.002), MSF (4.3±2 vs 8.8±4.6 μg/dl, P=0.006) and 24-h UFC (50.1±21.1 vs 117.9±42.4 μg/24 h, P=0.0007) and a significant rise in mean±s.d. morning plasma ACTH levels (22.2±9.6 vs 6.9±4.8 pg/ml, P=0.002). Improvement in co-morbidities was seen only in the surgical group, whereas no changes were noted in the follow-up group.CONCLUSIONS: Our early results show that removal of the largest lesion offers significant improvement both to cortisol excess and its metabolic consequences, without the debilitating effects of bilateral adrenalectomy. A larger number of patients, as well as a longer follow-up, are required before drawing solid conclusions.

AB - OBJECTIVE: The treatment of subclinical hypercortisolism in patients with bilateral adrenal incidentalomas (AI) is debatable. We aimed to compare the biochemical and clinical outcome of unilateral adrenalectomy vs a conservative approach in these patients.DESIGN: Retrospective study.METHODS: The study included 33 patients with bilateral AI; 14 patients underwent unilateral adrenalectomy of the largest lesion (surgical group), whereas 19 patients were followed up (follow-up group). At baseline and at each follow-up visit, we measured 0800 h plasma ACTH, midnight serum cortisol (MSF), 24-h urinary-free cortisol (UFC) and serum cortisol following a standard 2-day low-dose-dexamethasone-suppression test (LDDST). We evaluated the following comorbidities: arterial hypertension, impaired glucose tolerance or diabetes mellitus, dyslipidemia and osteoporosis.RESULTS: Baseline demographic, clinical characteristics and the duration of follow-up (53.9±21.3 vs 51.8±20.1 months, for the surgical vs the follow-up group) were similar between groups. At the last follow-up visit the surgical group had a significant reduction in post-LDDST cortisol (2.4±1.6 vs 6.7±3.9 μg/dl, P=0.002), MSF (4.3±2 vs 8.8±4.6 μg/dl, P=0.006) and 24-h UFC (50.1±21.1 vs 117.9±42.4 μg/24 h, P=0.0007) and a significant rise in mean±s.d. morning plasma ACTH levels (22.2±9.6 vs 6.9±4.8 pg/ml, P=0.002). Improvement in co-morbidities was seen only in the surgical group, whereas no changes were noted in the follow-up group.CONCLUSIONS: Our early results show that removal of the largest lesion offers significant improvement both to cortisol excess and its metabolic consequences, without the debilitating effects of bilateral adrenalectomy. A larger number of patients, as well as a longer follow-up, are required before drawing solid conclusions.

KW - Adrenal Cortex Neoplasms/metabolism

KW - Adrenal Gland Neoplasms/epidemiology

KW - Adrenalectomy/methods

KW - Adrenocortical Adenoma/epidemiology

KW - Aged

KW - Asymptomatic Diseases

KW - Case-Control Studies

KW - Cohort Studies

KW - Comorbidity

KW - Cushing Syndrome/epidemiology

KW - Diabetes Mellitus/epidemiology

KW - Dyslipidemias/epidemiology

KW - Female

KW - Glucose Intolerance/epidemiology

KW - Humans

KW - Hydrocortisone/blood

KW - Hypertension/epidemiology

KW - Male

KW - Middle Aged

KW - Osteoporosis/epidemiology

KW - Retrospective Studies

KW - Treatment Outcome

U2 - 10.1530/EJE-15-0566

DO - 10.1530/EJE-15-0566

M3 - Article

C2 - 26330465

VL - 173

SP - 719

EP - 725

JO - European Journal of Endocrinology

JF - European Journal of Endocrinology

SN - 0804-4643

IS - 6

ER -