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

I Perogamvros; D A Vassiliadi; O Karapanou; E Botoula; M Tzanela; S Tsagarakis

doi:10.1530/EJE-15-0566

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 journal › Article › peer-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

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

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

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 -