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

Objective: To assess the metabolic effects of adrenalectomy in patients with mild autonomous cortisol secretion (MACS). Background: 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. Methods: 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). Results: 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. Conclusions: Adrenalectomy improved weight, glucose, and BP control in patients with MACS.