DOI: 10.1097/sla.0000000000006183 ISSN: 0003-4932

Adrenalectomy Improves Body Weight, Glucose, and Blood Pressure Control in Patients with Mild Autonomous Cortisol Secretion

Jung-Min Koh, Keeho Song, Mi Kyung Kwak, Sunghwan Suh, Beom-Jun Kim, Tae-Yon Sung, Jun Hyuk Hong, Byong Chang Jeong, Jae Hyeon Kim, Seung Hun Lee
  • Surgery


To assess the metabolic effects of adrenalectomy in patients with mild autonomous cortisol secretion (MACS).


Despite retrospective studies showing the association of adrenalectomy for MACS with beneficial metabolic effects, there have been only two randomized prospective studies with some limitations to date.


A prospective, multicenter study randomized 132 patients with adrenal incidentaloma without any features of Cushing’s syndrome but with serum cortisol>50 nmol/L after a 1 mg overnight dexamethasone suppression test (F-1mgODST) into an adrenalectomy group (n=66) or control group (n=66). The primary outcomes were changes in body weight, glucose, and blood pressure (BP).


Among the 118 participants who completed the study with a median follow-up duration of 48 months (range: 3–66), the adrenalectomy group (n=46) exhibited a significantly higher frequency of improved weight control, glucose control, and BP control (32.6%, 45.7%, and 45.7%, respectively) compared to the control group (n=46; 6.5%, P=0.002; 15.2%, P=0.002; and 23.9%, P=0.029, respectively) after matching for age and sex. Adrenalectomy (odds ratio [OR]=10.38, 95% confidence interval [95% CI]=2.09–51.52, P=0.004), body mass index (OR=1.39, 95% CI=1.08–1.79, P=0.010), and F-1mgODST levels (OR=92.21, 95% CI=5.30–1604.07, P=0.002) were identified as independent factors associated with improved weight control. Adrenalectomy (OR=5.30, 95% CI=1.63–17.25, P=0.006) and diabetes (OR=8.05, 95% CI=2.34–27.65, P=0.001) were independently associated with improved glucose control. Adrenalectomy (OR=2.27, 95% CI=0.87–5.94, P=0.095) and hypertension (OR=10.77, 95% CI=3.65–31.81, P<0.001) demonstrated associations with improved BP control.


Adrenalectomy improved weight, glucose, and BP control in patients with MACS.

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