Adrenalectomy Improves Body Weight, Glucose, and Blood Pressure Control in Patients with Mild Autonomous Cortisol Secretion: Results of an RCT by the Co-work of Adrenal Research (COAR) Study

Jung-Min Koh; Keeho Song; Mi Kyung Kwak; Sunghwan Suh; Beom-Jun Kim; Tae-Yon Sung; Jun Hyuk Hong; Byong Chang Jeong; Jae Hyeon Kim; Seung Hun Lee

doi:10.1097/SLA.0000000000006183

Adrenalectomy Improves Body Weight, Glucose, and Blood Pressure Control in Patients with Mild Autonomous Cortisol Secretion: Results of an RCT by the Co-work of Adrenal Research (COAR) Study

Ann Surg. 2023 Dec 21. doi: 10.1097/SLA.0000000000006183. Online ahead of print.

Authors

Affiliations

¹ Division of Endocrinology and Metabolism, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
² Division of Endocrinology and Metabolism, Department of Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
³ Division of Endocrinology and Metabolism, Hallym University Dongtan Sacred Heart Hospital, Dongtan, Korea.
⁴ Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
⁵ Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul Korea.
⁶ Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
⁷ Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
⁸ Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

PMID: 38126763
DOI: 10.1097/SLA.0000000000006183

Abstract

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.