Endocrine Abstracts

Background and aims: It is known that unilateral adrenalectomy as treatment for autonomous secreting adrenal cortex adenomas effectively reduces cardiometabolic risk. Non-autonomous secreting adenomas are not expected to increase cardiometabolic risk, but this has not been thoroughly explored.We evaluated the blood pressure and glycemic profile before and after unilateral adrenalectomy for both autonomous and non-autonomous secreting adrenal cortex adenomas.

Patients and methods: This is a retrospective study of 30 consecutive patients submitted to unilateral adrenalectomy, assisted in a tertiary hospital.We evaluated systolic (SBP) and diastolic (DBP) arterial blood pressure, fasting glycemia,sodium (Na), potassium (K) and number of anti-hypertensive and anti-diabetic agents, 6 months before and after undergoing unilateral adrenalectomy for both secretory and non-secretory adrenal cortex adenomas.

Results: Patients’ mean age was 55±13 (21–77) years old and 70% were female. 9 (30%) had a cortisol or aldosterone secreting adenoma documented before surgery. Overall, mean tumor’s maximum diameter was 29±12 mm. 15 (50%) patients had hypertension and 3 (10%) were diagnosed with diabetes mellitus before surgery,requiring a mean of 1.2±0.3 anti-hypertensive drugs and 0.3±0.7 anti-diabetic agents per patient. After surgery, there was a significant reduction of the SBP (148±21–123±10 mmHg, P=0.001) and DBP(92±16–78±8 mmHg, P=0.006), an increase in serum potassium levels (4.1±0.5–4.5±0.6 mEq/l, P=0.015), a decrease in the number of anti-hypertensive agents (2.3±1.4 to 1.3±1.3 agents, P=0.008) and a decrease in fasting glycemia (121±50–101±31 mg/dL, P=0.02). Considering non-secretory adenomas separately, there was still a significant reduction of the SBP (147±26 mmHg to 122±11 mmHg, P=0.022), an increase in K levels (4.0±0.4 mEq/l to 4.6±0.6 mEq/l, P=0.006) and a trend towards less anti-hypertensive agents (2.1±1.3 to 1.4±1.4 agents, P=0.054). For patients with secreting adenomas there was a significant reduction in SBP (P=0.018) and DBP (P=0.02) and a trend to a lower fasting glycemia (P=0.092) after surgery.

Discussion: As expected, cardiometabolic profile improved in patients submitted to adrenalectomy for autonomous secreting adrenal adenomas.Notably, whatever the underlying mechanism,we also found an improvement in SBP and less need for anti-hypertensive agents after adrenalectomy for adenomas previously classified as non-autonomous secreting by clinical and biochemical evaluation.As a result, in both secreting and non-secreting tumors there was an improvement in cardiometabolic profile, which may improve long time cardiovascular outcomes.