Ueland Grethe Å, Ragnarsson Oskar, Heie Anette, Kjellbom Albin, Lindgren Ola, Muth Andreas, Palazzo Fausto, Poulsen Per L, Rolighed Lars, Thordarson Hrafnkell Baldur, Wernig Florian, Bergenfelz Anders
Endocr Connect. 2025 Jul 19;14(7). doi: 10.1530/EC-25-0361. Print 2025 Jul 1.
Evaluate the impact of adrenalectomy on metabolic parameters and quality of life (QoL) in patients with mild autonomous cortisol secretion (MACS).
A multicenter prospective randomized clinical trial compared adrenalectomy with conservative management. Metabolic parameters and QoL were assessed at baseline and after 2 years.
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.
Adrenalectomy showed trends toward improvement in office blood pressure and glucose metabolism in MACS, suggesting possible reduction in cardiovascular risk and metabolic complications.
NCT01246739.
评估肾上腺切除术对轻度自主性皮质醇分泌（MACS）患者代谢参数及生活质量（QoL）的影响。
一项多中心前瞻性随机临床试验将肾上腺切除术与保守治疗进行比较。在基线及2年后评估代谢参数和生活质量。
43例患有单个肾上腺腺瘤且患有MACS的患者被随机分为肾上腺切除术组（n = 21）或保守治疗组（n = 22）。基线时，33例患者患有高血压，13例患有2型糖尿病（T2D），18例使用他汀类药物，9例患者患有骨质疏松症。2年后，1 mg地塞米松抑制试验后皮质醇水平正常化的情况在肾上腺切除术组的19/21例患者中实现，而保守治疗组为2/22例患者（P < 0.01）。所有肾上腺切除术患者的促肾上腺皮质激素（ACTH）和脱氢表雄酮硫酸盐（DHEA-S）均显著升高。12例肾上腺切除术患者中有9例诊室血压及每日规定剂量的降压药（DDD）得到改善，而15例保守治疗患者中有4例得到改善（P = 0.01）。采用24小时血压及DDD评估，肾上腺切除术组11例中有5例改善，保守治疗组15例中有6例改善（P = 0.78）。在无T2D的患者中，肾上腺切除术组口服葡萄糖耐量试验期间120分钟血糖水平较低（6.2 vs 7.3 mmol/L，P = 0.04），但组内变化无差异（P = 0.76）。两组生活质量无统计学显著差异。
肾上腺切除术在MACS患者的诊室血压和糖代谢方面显示出改善趋势，提示可能降低心血管风险和代谢并发症。
NCT01246739。
