American journal of surgery · 2026
The effect of adrenalectomy on the patients with Mild Autonomous Cortisol Secretion.
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Kostek Mehmet, Roy Raj, Gillis Andrea, Chen Herbert, Lindeman Brenessa
Аннотация
BACKGROUND: Mild Autonomous Cortisol Secretion (MACS) is associated with cardiometabolic comorbidities, but the benefit of adrenalectomy remains controversial.
METHODS: We retrospectively reviewed patients undergoing adrenalectomy between October 2019 and October 2024. MACS was defined as post-1 mg dexamethasone suppression test cortisol 1.8-5.0 μg/dL without overt Cushing's syndrome. Pre- and postoperative clinical and biochemical outcomes were analyzed.
RESULTS: Thirty-eight patients met inclusion criteria (median age 64 years; 60.5% female). Median post-DST cortisol was 2.9 μg/dL, with a median follow-up of 258 days. Significant postoperative improvements were observed in systolic (p = 0.001) and diastolic (p = 0.004) blood pressure, HbA1c (p = 0.013), and antihypertensive medication burden (p = 0.009). General health status, HbA1c and number of antihypertensive medications improved in 76.3%, 58.4% and 52.8% of the patients, respectively. Clinical outcomes did not differ between patients with cortisol levels <2.5 vs. ≥2.5 μg/dL.
CONCLUSION: Adrenalectomy in selected MACS patients is associated with improvements in blood pressure, glycemic control, and overall health, independent of preoperative cortisol levels.
METHODS: We retrospectively reviewed patients undergoing adrenalectomy between October 2019 and October 2024. MACS was defined as post-1 mg dexamethasone suppression test cortisol 1.8-5.0 μg/dL without overt Cushing's syndrome. Pre- and postoperative clinical and biochemical outcomes were analyzed.
RESULTS: Thirty-eight patients met inclusion criteria (median age 64 years; 60.5% female). Median post-DST cortisol was 2.9 μg/dL, with a median follow-up of 258 days. Significant postoperative improvements were observed in systolic (p = 0.001) and diastolic (p = 0.004) blood pressure, HbA1c (p = 0.013), and antihypertensive medication burden (p = 0.009). General health status, HbA1c and number of antihypertensive medications improved in 76.3%, 58.4% and 52.8% of the patients, respectively. Clinical outcomes did not differ between patients with cortisol levels <2.5 vs. ≥2.5 μg/dL.
CONCLUSION: Adrenalectomy in selected MACS patients is associated with improvements in blood pressure, glycemic control, and overall health, independent of preoperative cortisol levels.