Department of EndocrinologyDiabetes and Metabolism, Evangelismos Hospital, 106 76 Athens, GreeceEndocrine UnitSecond Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Center, Attiko University Hospital, 12462 Athens, Greece.
Eur J Endocrinol. 2015 Dec;173(6):719-25. doi: 10.1530/EJE-15-0566. Epub 2015 Sep 1.
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.
Retrospective study.
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.
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.
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.
双侧肾上腺意外瘤（AI）患者亚临床皮质醇增多症的治疗存在争议。我们旨在比较这些患者单侧肾上腺切除术与保守治疗的生化和临床结局。
回顾性研究。
该研究纳入了 33 例双侧 AI 患者；14 例患者接受了最大病变的单侧肾上腺切除术（手术组），而 19 例患者接受了随访（随访组）。在基线和每次随访时，我们测量了 0800 小时血浆 ACTH、午夜血清皮质醇（MSF）、24 小时尿游离皮质醇（UFC）和标准 2 天小剂量地塞米松抑制试验（LDDST）后的血清皮质醇。我们评估了以下合并症：动脉高血压、糖耐量受损或糖尿病、血脂异常和骨质疏松症。
两组间的基线人口统计学、临床特征和随访时间（手术组为 53.9±21.3 个月，随访组为 51.8±20.1 个月）相似。在最后一次随访时，手术组 LDDST 后皮质醇（2.4±1.6 对 6.7±3.9μg/dl，P=0.002）、MSF（4.3±2 对 8.8±4.6μg/dl，P=0.006）和 24 小时 UFC（50.1±21.1 对 117.9±42.4μg/24 小时，P=0.0007）显著降低，平均±标准差早晨血浆 ACTH 水平显著升高（22.2±9.6 对 6.9±4.8pg/ml，P=0.002）。仅在手术组中观察到合并症的改善，而随访组无变化。
我们的早期结果表明，切除最大病变可显著改善皮质醇过多及其代谢后果，而不会产生双侧肾上腺切除术的致残影响。需要更多的患者和更长的随访时间，才能得出可靠的结论。
