ArticleJournal of endocrinological investigation2026
Adrenalectomy improves cardiovascular profile in patients with mild autonomous cortisol secretion: extension of a multicenter randomized controlled trial to 12 months.
Article in Journal of endocrinological investigation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThe best therapeutic approach in patients with mild autonomous cortisol secretion (MACS) is debated. In this extension of a randomized controlled trial to 12 months we aimed to evaluate the effect of adrenalectomy on blood pressure, cardiac structure and coagulation factors in outpatients with MACS.
methodspatients with unilateral adrenal incidentaloma ≥ 1 cm and cortisol after 1 mg dexamethasone suppression test (F-1mgDST) between 1.8 (50 nmol/L) and 5 µg/dL (138 nmol/L) were enrolled and randomized to adrenalectomy (Arm-A) or conservative approach (Arm-B). Blood pressure control, echocardiographic indices and coagulation factors, were assessed at baseline and 12 months after recovery or observation, in Arm-A and Arm-B, respectively.
results51 subjects (23/28 in Arm-A/Arm-B) were enrolled. At follow-up the prevalence of blood pressure improvement was higher in Arm-A (10/23 patients, 43.5%) than in Arm-B patients (4/28 patients, 14.3%, p = 0.02). The improvement of blood pressure control was 5.4-fold more frequent in Arm-A patients (CI, 1.16–24.9 p = 0.03), regardless of confounding factors. In Arm-A, left ventricular mass, left atrial area and the prevalence of left atrial dilatation decreased at follow-up (96.4 ± 28.8 vs 87.6 ± 25,6 g/m2, p = 0.02; 28.4 ± 9.9 vs 22.6 ± 12.4 cm2, p = 0.04, 70.6% vs 35.3% p = 0.04, respectively) whereas all these parameters remained stable in Arm-B. At the end of follow-up, Arm-A patients had a lower prevalence of altered anti-coagulant parameters than Arm-B patients (2/19 patients, 10.5% vs 13/24 patients 54.2%, respectively, p = 0.002).
conclusionIn patients with MACS, surgery ameliorates blood pressure, cardiac structure, and coagulation factors.
trial registrationNCT number 04860180.
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