Randomized trial studying metabolic outcomes and quality of life after adrenalectomy versus conservative management for mild autonomous cortisol secretion.

OBJECTIVE

Evaluate the impact of adrenalectomy on metabolic parameters and quality of life (QoL) in patients with mild autonomous cortisol secretion (MACS).

METHOD

A multicenter prospective randomized clinical trial compared adrenalectomy with conservative management. Metabolic parameters and QoL were assessed at baseline and after 2 years.

RESULTS

Forty-three MACS patients with a single adrenal adenoma were randomized to either adrenalectomy (n = 21) or conservative management (n = 22). At baseline, 33 patients had hypertension, 13 had type 2 diabetes (T2D), 18 used statins, and nine patients had osteoporosis. After 2 years, normalization of cortisol levels post 1 mg dexamethasone suppression test was achieved in 19/21 adrenalectomy patients compared to 2/22 patients in the conservative group (P < 0.01). All adrenalectomy patients had a significant increase in ACTH and DHEA-S. Office blood pressure and daily defined doses of antihypertensives (DDD) improved in nine of 12 adrenalectomy patients versus four of 15 conservatively treated patients (P = 0.01). Using 24 h blood pressure and DDD, improvement rates were five of 11 in the adrenalectomy group and six of 15 in the conservative group (P = 0.78). Among patients without T2D, the 120 min glucose level during oral glucose tolerance test was lower in the adrenalectomy group (6.2 vs 7.3 mmol/L, P = 0.04), but within-group changes were not different (P = 0.76). There were no statistically significant differences in QoL between the two groups.

CONCLUSION

Adrenalectomy showed trends toward improvement in office blood pressure and glucose metabolism in MACS, suggesting possible reduction in cardiovascular risk and metabolic complications.

CLINICAL TRIALS NUMBER

NCT01246739.