Clinical Benefits of Unilateral Adrenalectomy in Patients with Subclinical Hypercortisolism Due to Adrenal Incidentaloma: Results from a Single Center

Petramala, Luigi; Cavallaro, Giuseppe; Galassi, Matteo; Marinelli, C.; Tonnarini, Gianfranco; Concistrè, Antonio; U, Costi; Bufi, M.; Lucia, P; Vincentis, Giuseppe De; Iannucci, Gino; Toma, Giorgio De; Letizia, Claudio

doi:10.1007/s40292-017-0182-7

Cited by 31 publications

(16 citation statements)

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“…Studies assessing surgical outcome in SCS patients showed significant improvement in blood pressure from baseline in most of the studies, improvement in glucose metabolism in more than half, and improved BMI in more than a third of the studies. In the study by Petramala et al .,[ 21 ] where outcome on metabolic syndrome (as per ATP III criteria)[ 35 ] was studied, there was significant improvement in metabolic syndrome following adrenalectomy in SCS patients. For the conservatively managed SCS group, only a single study showed a significant worsening of HTN.…”

Section: Discussionmentioning

confidence: 99%

“…Results from studies on outcomes of adrenalectomy have been conflicting but in general, the data indicated an improvement in metabolic complications, especially in blood pressure and diabetes, in patients with subclinical cortisol secreting AI after unilateral adrenalectomy, and deterioration or no improvement in patients treated conservatively. Five studies in the review directly compared the difference between surgical and medical outcomes and assessed changes in cardiovascular risk factors in the long term[ 19 21 23 24 27 ] including one prospective randomized study. [ 23 ] Petramala et al .…”

Section: Discussionmentioning

confidence: 99%

“…also investigated metabolic syndrome (as per ATP III criteria)[ 35 ] and the ambulatory BP (nondipper profile) and found a significant improvement in metabolic syndrome and nondipper profile in SCS group managed by adrenalectomy. [ 21 ]…”

Section: Discussionmentioning

confidence: 99%

“…A total of 15 cohort studies (5 prospective and 10 retrospective), 1 randomized controlled trial (RCT), and 2 cross-sectional studies were included in the systematic review. Studies were mostly from European centers; 9 of the studies originated from Italy,[ 2 16 17 18 19 20 21 22 23 ] 4 from Japan,[ 24 25 26 27 ] 2 from Greece,[ 28 29 ] and 1 each from Turkey,[ 30 ] Hungary,[ 31 ] and Korea. [ 32 ] The studies were published between 2002 and 2017.…”

Section: R Esultsmentioning

confidence: 99%

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Nonfunctioning and subclinical cortisol secreting adrenal incidentalomas and their association with metabolic syndrome: A systematic review

Khan

2019

Indian J Endocr Metab

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: R Esultsmentioning

confidence: 99%

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Nonfunctioning and subclinical cortisol secreting adrenal incidentalomas and their association with metabolic syndrome: A systematic review

Khan

2019

Indian J Endocr Metab

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“…The lack of classic features of PHEO in our patient can be explained by the repeated normal urinary metanephrines. Hormonal evaluation revealed autonomous glucocorticoid production without specific signs and symptoms of hypercortisolism [4] . Histopathological examination of the adrenal mass revealed PHEO associated with corticomedullary hyperplasia.…”

Section: Discussionmentioning

confidence: 99%

Silent Adrenal Pheochromocytoma Coexistent with Corticomedullary Hyperplasia: A Case Incidentally Discovered

Petramala

Olmati

Concistrè

et al. 2017

European Journal of Case Reports in Internal Medicine

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Introduction: Pheochromocytoma (PHEO) is a rare catecholamine-producing tumour arising from chromaffin cells in the sympatho-adrenal system, and can present as asymptomatic adrenal incidentaloma (AI). Patient: We describe the case of a 61-year-old woman with a right adrenal mass incidentally discovered, who was biochemically characterized with subclinical hypercortisolism (SH). The patient was scheduled for adrenalectomy because of increasing seizure of the right adrenal gland with a haemorrhagic and focal pseudocystic appearance macroscopically, incidental histological and immunohistochemical PHEO, and micronodular cortico-adrenal hyperplasia. Discussion: This report describes a rare case of incidental non-functioning PHEO coexisting with corticomedullary hyperplasia and SH.LEARNING POINTS • Rare presentation of coexisting common (adrenal incidentaloma and subclinical Cushing's syndrome) and uncommon (pheochromocytoma) endocrinological conditions.

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Evaluation and Treatment of Patients With Hypercortisolism

Miller

Auchus

2020

JAMA Surg

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lthough different across races and ethnicities, the incidence of hypercortisolism ranges from 0.2 to 5.0 cases per million per year with an estimated prevalence of 39 to 79 cases per million in various populations. [1][2][3][4] However, considerable underdiagnosis is likely, especially in the case of mild autonomous cortisol secretion (MACS, formerly known as subclinical Cushing syndrome). The incidence of MACS in patients with adrenal incidentalomas ranges from 5% to 30%. 5,6 In patients with hypertension, diabetes, obesity, and osteoporosis, the incidence of MACS reaches 10%. Chronic diseases, such as hypertension, diabetes, obesity, and osteoporosis, affect nearly half of the US population, are costly, and are among the nation's leading causes of death and disability. 7 The need to limit development and unrecognized persistence of these potentially curable conditions that lead to chronic disease is of great importance and should be a focus of attention.Surgeons often encounter patients with hypertension, type 2 diabetes, obesity, and bone density loss. These common comorbidities are associated with increased morbidity and mortality in patients undergoing surgery. In some, hypercortisolism is the underlying cause of these comorbidities. Depending on the origin, site, and degree of excess cortisol production, hypercortisolism may be classified as Cushing disease, Cushing syndrome, ectopic Cushing syndrome, or MACS. An understanding of the outcomes, challenges in diagnosis, and management of hypercortisolism will assist surgeons in caring for these patients. With knowledge of the adverse outcomes of hypercortisolism and strategies to mitigate these, improved surgical outcomes may follow. Enhanced preoperative evaluation and preparation of patients for surgery and incorporation of intraoperative tactics to minimize bleeding, infection, anastomotic leak, and wound dehiscence are important to optimize outcomes in these patients. Postoperative pathways to optimize recovery are often overlooked but are vital to long-term functional status.This review examines hypercortisolism from a surgeon's viewpoint and considers the present and future state of disease management. Included with a basic review of pathophysiology, evaluation, and general management of hypercortisolism is a discussion of specific organ system outcomes, pitfalls in the diagnosis of hypercortisolism, and preoperative, perioperative, and postoperative management considerations. Population health outcomes and the potential role surgeons can play in treating patients with MACS are also discussed. Higher-level considerations are put forth to encourage a long-term view of future work needed to optimally care for these patients. PathophysiologyCorticotropin-releasing factor is produced in the hypothalamus and stimulates production of adrenocorticotropin hormone (ACTH) IMPORTANCE With the potential for severe adverse effects of hypercortisolism, the need to limit the development and unrecognized persistence of sequelae from cortisol excess is of great importan...

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Clinical Benefits of Unilateral Adrenalectomy in Patients with Subclinical Hypercortisolism Due to Adrenal Incidentaloma: Results from a Single Center

Abstract: Our study confirm the high prevalence of SH in AI, and the unilateral laparoscopic adrenalectomy seemed to have a beneficial effect on some cardiometabolic disorders.

Cited by 31 publications

References 29 publications

Nonfunctioning and subclinical cortisol secreting adrenal incidentalomas and their association with metabolic syndrome: A systematic review

Nonfunctioning and subclinical cortisol secreting adrenal incidentalomas and their association with metabolic syndrome: A systematic review

Silent Adrenal Pheochromocytoma Coexistent with Corticomedullary Hyperplasia: A Case Incidentally Discovered

Evaluation and Treatment of Patients With Hypercortisolism

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