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

Ueland, Grethe ; Ragnarsson, Oskar ; Heie, Anette ; Kjellbom, Albin LU orcid ; Lindgren, Ola LU ; Muth, Andreas ; Palazzo, Fausto ; Poulsen, Per L. ; Rolighed, Lars and Thordarson, Hrafnkell Baldur , et al. (2025) In Endocrine Connections 14(7).
Abstract

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... (More)

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.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
adrenal incidentalomas, adrenalectomy, MACS, metabolic consequences, mild autonomous cortisol secretion
in
Endocrine Connections
volume
14
issue
7
article number
e250361
publisher
BioScientifica
external identifiers
  • scopus:105012181235
  • pmid:40600855
ISSN
2049-3614
DOI
10.1530/EC-25-0361
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 the author(s).
id
82ae0d76-f85c-4013-99bd-5248391d75ee
date added to LUP
2025-12-15 15:15:43
date last changed
2026-01-12 18:18:20
@article{82ae0d76-f85c-4013-99bd-5248391d75ee,
  abstract     = {{<p>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 &lt; 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.</p>}},
  author       = {{Ueland, Grethe and Ragnarsson, Oskar and Heie, Anette and Kjellbom, Albin and Lindgren, Ola and Muth, Andreas and Palazzo, Fausto and Poulsen, Per L. and Rolighed, Lars and Thordarson, Hrafnkell Baldur and Wernig, Florian and Bergenfelz, Anders}},
  issn         = {{2049-3614}},
  keywords     = {{adrenal incidentalomas; adrenalectomy; MACS; metabolic consequences; mild autonomous cortisol secretion}},
  language     = {{eng}},
  number       = {{7}},
  publisher    = {{BioScientifica}},
  series       = {{Endocrine Connections}},
  title        = {{Randomized trial studying metabolic outcomes and quality of life after adrenalectomy versus conservative management for mild autonomous cortisol secretion}},
  url          = {{http://dx.doi.org/10.1530/EC-25-0361}},
  doi          = {{10.1530/EC-25-0361}},
  volume       = {{14}},
  year         = {{2025}},
}