Scholarlink

Purpose <p>The best therapeutic approach in patients with mild autonomous cortisol secretion (MACS) is debated. In this extension of a randomized controlled trial to 12&#xa0;months we aimed to evaluate the effect of adrenalectomy on blood pressure, cardiac structure and coagulation factors in outpatients with MACS.</p> Methods <p>patients with unilateral adrenal incidentaloma ≥ 1&#xa0;cm and cortisol after 1&#xa0;mg dexamethasone suppression test (F-1mgDST) between 1.8 (50&#xa0;nmol/L) and 5&#xa0;µg/dL (138&#xa0;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&#xa0;months after recovery or observation, in Arm-A and Arm-B, respectively.</p> Results <p>51 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&#xa0;g/m<sup>2</sup>, p = 0.02; 28.4 ± 9.9 vs 22.6 ± 12.4 cm<sup>2</sup>, 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).</p> Conclusion <p>In patients with MACS, surgery ameliorates blood pressure, cardiac structure, and coagulation&#xa0;factors.</p> Trial registration <p>NCT number 04860180.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Adrenalectomy improves cardiovascular profile in patients with mild autonomous cortisol secretion: extension of a multicenter randomized controlled trial to 12 months

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年4月6日

查看全文
  • Valentina Morelli,
  • Maria Strata,
  • Serena Palmieri,
  • Carmen Aresta,
  • Vittoria Favero,
  • Sofia Frigerio,
  • Flavia Pugliese,
  • Antonio Musolino,
  • Alberta Dall’Antonia,
  • Sabrina Corbetta,
  • Maura Arosio,
  • Alfredo Scillitani,
  • Iacopo Chiodini

摘要

Purpose

The 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.

Methods

patients 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.

Results

51 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).

Conclusion

In patients with MACS, surgery ameliorates blood pressure, cardiac structure, and coagulation factors.

Trial registration

NCT number 04860180.