Endocrine Abstracts

Objective: According to some authors a higher incidence of subclinical hypercortisolaemia is found among patients with bilateral adrenal tumors with benign phenotype than with unilateral ones. The question is whether all patients with bilateral adrenal tumors and subclinical hypercortisolemia should undergo surgery and, if yes, which of the tumors should be removed first.

Patients and methods: The investigated group consisted of 25 patients with benign bilateral adrenal tumors and subclinical hypercortisolemia. Measurements of cortisol concentration at 0800, 2200 and the following morning after dexamethasone suppression were done. Blood morning levels of ACTH, DHEAS, 17OHPG, concentration of HbA1c bin, and lipid fractions were determined. 24 patients were operated. The adrenal gland for removing was typed basing on scintigraphy or on tumor diameter. The above listed measurements were repeated 1, 6, and 12 months after surgery.

Results: In all operated patients the biochemical signs of hypercortisolaemia ceased after surgery. However only in 14 (58%) of them the clinical improvement was evident. Only subjects with deteriorated control of diabetes, hypertension or a quick increment of body mass before surgery have experienced benefits from surgical treatment.

Conclusion: Even though unilateral adrenalectomy brings about regression of subclinical hypercortisolemia in all operated patients with bilateral adrenal tumors, the clinical improvement is apparent only in cases with worsening of comorbidities (hypertension, obesity, and type 2 diabetes).