EYES2023 ESE Young Endocrinologists and Scientists (EYES) 2023 Oral communication 1: Adrenal Diseases (8 abstracts)
Outcome of surgical versus conservative management in patients with mild autonomous cortisol secretion
Madalina Elena Iftimie 1 , Iulia Burcea 2 , Ramona Dobre 2 , Ionela Baciu 2 , Dan Alexandru Niculescu 3 , Cristina Căpăţână 2 , Simona Găloiu 2 , Radian Şerban 2 , Nicoleta Baculescu 2 , Raluca Trifănescu 2 & Catalina Poiana 4
1‘C.I.Parhon’ National Institute of Endocrinology, Clinical Endocrinology I, Bucharest, Romania; 2‘Carol Davila’ University of Medicine and Pharmacy; ‘C.I. Parhon’ Institute of Endocrinology, Bucharest, Romania; 3‘C.I.Parhon’ National Institute of Endocrinology, Romania; 4‘Carol Davila’ University of Medicine and Pharmacy, ‘C.I. Parhon’ Institute of Endocrinology, Bucharest, Romania.
Background: Adrenal incidentalomas (AI) with mild autonomous cortisol secretion (MACS) are associated with increased morbidity and mortality and constitute a common clinical scenario.
Objective: We assessed the outcome of cardiovascular risk factors associated with MACS after adrenalectomy versus conservative management.
Methods: Retrospective study performed on a cohort of patients evaluated in our clinic between 2018 and 2022 with an AI and an impaired response to 1 mg dexamethasone suppression test (DST), after exclusion of overt hormone excess, mixed hormonal secretion, malignancy and glucocorticoid medication.
Results: Of the 481 patients with AI evaluated, 14.55% had MACS, but only 10.81% were included in the study, with a median follow up of 21 months (9–77.25). 48.08% (n=25, aged 58.4±9.42 years, 96% women) underwent surgery and the other 51.92% (n=27, aged 59.52±8.05 years, 77.8% women) were managed conservatively. The mean tumor diameter was significantly higher in the surgery group (36.44±12.88 mm vs 23.79±11.3 mm), while bilateral masses were more prevalent in those conservatively treated (51.9% vs 36%). Surgery was performed in cases with higher cortisol values after 1 mg DST (3.54 μg/dl, 2.66–6.23, P=0.003) and lower ACTH levels (4.71 pg/ml, 2.51–7.06, P<0.001). Surgery was moderately correlated with an improvement in arterial hypertension (r=0.351, P=0.014), 45.45% of the operated patients requiring less or no hypotensive drugs compared to 11.53% non-operated patients (P=0.008). The latter showed a slightly better control of glucidic metabolism (P=0.077) and lower triglyceride levels at the last visit (P=0.026).
Conclusion: When assessing adrenalectomy as a treatment option for patients with AI and MACS, we need an individualized approach, considering our heterogeneous results and the low-to-moderate-quality evidence available in the literature comparing surgery with the best management of associated comorbid conditions in these patients.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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