Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Centre, Albinusdreef 2, Leiden 2333 ZA, The Netherlands.
Department of Clinical Epidemiology, Leiden University Medical Centre, Albinusdreef 2, Leiden 2333 ZA, The Netherlands.
Eur J Endocrinol. 2023 Oct 17;189(4):S88-S101. doi: 10.1093/ejendo/lvad134.
To assess (1) comorbidities associated with and (2) treatment strategies for patients with adrenal incidentalomas and mild autonomous cortisol secretion (MACS; > 1.8 µg/dL (>50 nmol/L) cortisol level cut-off following the 1 mg dexamethasone suppression test).
Systematic review and meta-analysis.
Seven databases were searched up to July 14, 2022. Eligible studies were (randomized) trials, cohort studies, and cross-sectional studies assessing comorbidities potentially attributable to cortisol excess or mortality in patients with adrenal incidentaloma with or without MACS or the effects of conservative or surgical management of MACS. Random-effects meta-analysis was performed to estimate pooled proportions (with 95% CIs).
In 30 cross-sectional and 16 cohort studies (n = 17 156 patients in total), patients with MACS had a higher prevalence of diabetes (relative risk [RR] 1.44 [1.23-1.69]), hypertension (RR = 1.24 [1.16-1.32]), and dyslipidemia (RR = 1.23 [1.13-1.34]). All-cause mortality (adjusted for confounders) in patients with MACS, assessed in 4 studies (n = 5921), was increased (hazard ratio [HR] = 1.54 [1.27-1.81]). Nine observational studies (n = 856) and 2 randomized trials (n = 107) suggest an improvement in glucometabolic control (RR = 7.99 [2.95-21.90]), hypertension (RR = 8.75 [3.99-19.18]), and dyslipidemia (RR = 3.24 [1.19-8.82]) following adrenalectomy.
The present systematic review and meta-analysis highlight the relevance of MACS, since both cardiometabolic morbidities and mortality appeared to have increased in patients with MACS compared to patients with non-functioning incidentalomas. However, due to heterogeneous definitions, various outcomes, selective reporting, and missing data, the reported pooled estimates need to be interpreted with caution. The small number of patients in randomized trials prevents any strong conclusion on the causality between MACS and these comorbidities.
评估（1）伴有肾上腺意外瘤和轻度自主皮质醇分泌（MACS；皮质醇水平>1.8μg/dL（>50nmol/L），在 1mg 地塞米松抑制试验后作为截断值）的患者的合并症，以及（2）这些患者的治疗策略。
系统评价和荟萃分析。
检索了截至 2022 年 7 月 14 日的 7 个数据库。合格的研究是（随机）试验、队列研究和横断面研究，评估了伴有或不伴有 MACS 的肾上腺意外瘤患者中皮质醇过多或死亡率相关的潜在合并症，或 MACS 的保守或手术治疗的效果。采用随机效应荟萃分析来估计汇总比例（95%CI）。
在 30 项横断面研究和 16 项队列研究（共 17156 例患者）中，MACS 患者的糖尿病（相对风险 [RR] 1.44 [1.23-1.69]）、高血压（RR=1.24 [1.16-1.32]）和血脂异常（RR=1.23 [1.13-1.34]）患病率更高。在 4 项研究（n=5921）中评估的 MACS 患者的全因死亡率（调整混杂因素后）增加（风险比 [HR] = 1.54 [1.27-1.81]）。9 项观察性研究（n=856）和 2 项随机试验（n=107）表明，肾上腺切除术可改善糖代谢控制（RR=7.99 [2.95-21.90]）、高血压（RR=8.75 [3.99-19.18]）和血脂异常（RR=3.24 [1.19-8.82]）。
本系统评价和荟萃分析强调了 MACS 的相关性，因为与无功能意外瘤患者相比，MACS 患者的心血管代谢合并症和死亡率似乎都有所增加。然而，由于定义不同、结局多样、选择性报告和数据缺失，报告的汇总估计值需要谨慎解释。随机试验中患者数量较少，无法就 MACS 与这些合并症之间的因果关系得出任何强有力的结论。
