Ren Xingxiang, Nan Min, Zhang Xiaomei
Department of Endocrinology, Peking University International Hospital, Beijing, China.
Front Endocrinol (Lausanne). 2024 Jul 17;15:1399311. doi: 10.3389/fendo.2024.1399311. eCollection 2024.
The management of Mild Autonomous Cortisol Secretion (MACS) remains a topic of debate among clinicians, with differing opinions on the effectiveness of surgical intervention compared to conservative treatment methods. This meta-analysis provides a comprehensive assessment of available literature to determine the most effective approach for treating this condition.
On December 1, 2023, an exhaustive literature search of English databases Embase, PubMed, the Cochrane Library, Scopus, Web of Science, as well as the Chinese databases China HowNet, Wanfang Database, SinoMed Database, and Weipu Database using the keywords "Mild Autonomous Cortisol Secretion", "Subclinical Cushing's Syndrome", "Subclinical Hypercortisolism", "Mild Cortisol Autonomous Secretion", "Adrenal Incidentaloma", "Surgical Treatment" and "Adrenalectomy". The data were statistically analyzed using STATA version 15.0.
In this comprehensive analysis involving 629 patients with MACS, the therapeutic efficacy of adrenalectomy was evident. The meta-analysis results indicate that compared to conservative treatment, surgical intervention more effectively improves obesity indicators in patients: waist circumference (SMD=-0.62, 95% CI: -1.06 to -0.18), BMI (SMD=-0.41, 95% CI: -0.62 to -0.20), enhances glycemic control: fasting blood glucose (SMD=-0.47, 95% CI: -0.68 to -0.26), glycated hemoglobin (SMD=-0.66, 95% CI: -0.95 to -0.38), improves lipid metabolism: triglycerides (SMD=-0.45, 95% CI: -0.73 to -0.16), lowers blood pressure: systolic blood pressure (SMD=-1.04, 95% CI: -1.25 to -0.83), diastolic blood pressure (SMD=-0.89, 95% CI: -1.12 to -0.65), and ameliorates hormonal metabolic disorder: 24h urinary free cortisol (SMD=-1.10, 95% CI: -1.33 to -0.87), ACTH (SMD=2.30, 95% CI: 1.63 to 2.97). All these differences are statistically significant.
This meta-analysis shows that, compared to conservative treatment, surgical treatment is more effective in improving obesity indicators, glycemic control, lipid metabolism, reducing blood pressure, and ameliorating hormonal metabolic disorders in patients with MACS. These statistically significant results highlight the importance of considering surgical intervention in the management of patients with MACS.
https://www.crd.york.ac.uk/prospero, identifier CRD42023492527.
轻度自主性皮质醇分泌（MACS）的管理仍是临床医生争论的话题，对于手术干预与保守治疗方法的有效性存在不同观点。本荟萃分析对现有文献进行全面评估，以确定治疗这种疾病的最有效方法。
2023年12月1日，使用关键词“轻度自主性皮质醇分泌”“亚临床库欣综合征”“亚临床皮质醇增多症”“轻度皮质醇自主性分泌”“肾上腺意外瘤”“手术治疗”和“肾上腺切除术”，对英文数据库Embase、PubMed、Cochrane图书馆、Scopus、科学网以及中文数据库知网、万方数据库、中国生物医学文献数据库和维普数据库进行详尽的文献检索。使用STATA 15.0对数据进行统计分析。
在这项涉及629例MACS患者的综合分析中，肾上腺切除术的治疗效果明显。荟萃分析结果表明，与保守治疗相比，手术干预能更有效地改善患者的肥胖指标：腰围（标准化均值差[SMD]= -0.62，95%置信区间[CI]：-1.06至-0.18）、体重指数（SMD= -0.41，95% CI：-0.62至-0.20），增强血糖控制：空腹血糖（SMD= -0.47，95% CI：-0.68至-0.26）、糖化血红蛋白（SMD= -0.66，95% CI：-0.95至-0.38），改善脂质代谢：甘油三酯（SMD= -0.45，95% CI：-0.73至-0.16），降低血压：收缩压（SMD= -1.04，95% CI：-1.25至-0.83）、舒张压（SMD= -0.89，95% CI：-1.12至-0.65），并改善激素代谢紊乱：24小时尿游离皮质醇（SMD= -1.10，95% CI：-1.33至-0.87）、促肾上腺皮质激素（SMD= 2.30，95% CI：1.63至2.97）。所有这些差异均具有统计学意义。
本荟萃分析表明，与保守治疗相比，手术治疗在改善MACS患者的肥胖指标、血糖控制、脂质代谢、降低血压和改善激素代谢紊乱方面更有效。这些具有统计学意义的结果凸显了在MACS患者管理中考虑手术干预的重要性。
