Evaluation of the Cardiovascular Risk in Patients with Subclinical Cushing Syndrome Before and After Surgery

Erbil, Yeşim; Ademoğlu, Evin; Özbey, Neşe; Barbaros, Umut; Yanık, Burcu Tulumoğlu; Salmaslıoğlu, Artür; Bozbora, Alp; Özarmağan, Selçuk

doi:10.1007/s00268-005-0681-x

Cited by 98 publications

(91 citation statements)

References 40 publications

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“…Indeed, some authors recommend a substitutive steroid therapy in all patients (10,17), while others only in those with pre-surgically suspected SH (5,7,18). This discordance depends on the fact that the prevalence of post-surgical hypocortisolism has been differently estimated in the different series, even in the more recent studies (12)(13)(14)(15)(16)(17)(18). In our opinion, this could be firstly due to the characteristics of the disease per se.…”

Section: Discussionmentioning

confidence: 48%

“…However, so far, no studies specifically investigated the possible association between the pre-surgical biochemical diagnosis of SH and the subsequent presence of post-surgical hypocortisolism. The prevalence of post-surgical hypocortisolism in patients, with and without SH, who underwent unilateral adrenalectomy for AI, varies depending on the criteria used to diagnose SH (12)(13)(14)(15)(16)(17)(18). In addition, most studies considered only post-surgical basal cortisol level or the presence of symptoms suggesting adrenal failure as a diagnostic tool for post-surgical hypocortisolism (12,15,17,18).…”

Section: Introductionmentioning

confidence: 99%

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Post-surgical hypocortisolism after removal of an adrenal incidentaloma: is it predictable by an accurate endocrinological work-up before surgery?

Eller-Vainicher¹,

Morelli²,

Salcuni³

et al. 2010

European Journal of Endocrinology

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Objective: Few data are available regarding the need of steroid substitutive therapy after unilateral adrenalectomy for adrenal incidentaloma (AI). It is unknown whether, before surgery, the hypothalamic-pituitary-adrenal (HPA) axis secretion parameters can predict post-surgical hypocortisolism. Aim: This study aimed to evaluate whether, in AI patients undergoing unilateral adrenalectomy, postsurgical hypocortisolism could be predicted by the parameters of HPA axis function. Design: Prospective, multicenter. Methods: A total of 60 patients underwent surgical removal of AI (surgical indication: 29 subclinical hypercortisolism (SH); 31 AI dimension). Before surgery, SH was diagnosed in patients presenting at least three criteria out of urinary free cortisol (UFC) levelsO60 mg/24 h, cortisol after 1-mg dexamethasone suppression test (1 mg-DST)O3.0 mg/dl, ACTH levels!10 pg/ml, midnight serum cortisol (MSC)O5.4 mg/dl. Two months after surgery, HPA axis function was assessed by low dose ACTH stimulation test or insulin tolerance test when needed: 39 patients were affected (Group B) and 21 were not affected (Group A) with hypocortisolism. The accuracy in predicting hypocortisolism of pre-surgical HPA axis parameters or their combinations was evaluated. Results: The presence of O2 alterations among 1 mg-DSTO5.0 mg/dl, ACTH!10 pg/ml, elevated UFC and MSC has the highest odds ratio (OR) for predicting post-surgical hypocortisolism (OR 10.45, 95% confidence interval, PZ0.001). Post-surgical hypocortisolism was predicted with 100% probability by elevated UFC plus MSC levels, but not ruled out even in the presence of the normality of all HPA axis parameters. Conclusion: Post-surgical hypocortisolism cannot be pre-surgically ruled out. A steroid substitutive therapy is indicated after unilateral adrenalectomy for SH or size of the adenoma.European Journal of Endocrinology 162 91-99

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Section: Discussionmentioning

confidence: 48%

Section: Introductionmentioning

confidence: 99%

Post-surgical hypocortisolism after removal of an adrenal incidentaloma: is it predictable by an accurate endocrinological work-up before surgery?

Eller-Vainicher¹,

Morelli²,

Salcuni³

et al. 2010

European Journal of Endocrinology

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“…The search yielded 854 references for abstract screening of which 26 studies (19,20,21,22,23,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49) were included in this systematic review (Fig. 1).…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…However, studies attempting to investigate the beneficial effect of adrenalectomy on cardiovascular risk factors in patients with SCS are characterized by small sample sizes and have generated inconsistent results. Although several authors reported various degrees of improvement in metabolic parameters (19,20,21), others showed no significant metabolic effect of adrenalectomy (22,23) in patients with autonomous glucocorticoid production.…”

mentioning

confidence: 99%

THERAPY OF ENDOCRINE DISEASE: Improvement of cardiovascular risk factors after adrenalectomy in patients with adrenal tumors and subclinical Cushing’s syndrome: a systematic review and meta-analysis

Bancos

Alahdab

Crowley

et al. 2016

European Journal of Endocrinology

136

110

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Objective: Beneficial effects of adrenalectomy on cardiovascular risk factors in patients with subclinical Cushing's syndrome (SCS) are uncertain. We sought to conduct a systematic review and meta-analysis with the following objectives: (i) determine the effect of adrenalectomy compared with conservative management on cardiovascular risk factors in patients with SCS and (ii) compare the effect of adrenalectomy on cardiovascular risk factors in patients with SCS vs those with a nonfunctioning (NF) adrenal tumor. Methods: MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE, EMBASE and Cochrane Central Register of Controlled Trial were searched on 17 November 2015. Reviewers extracted data and assessed methodological quality in duplicate. Results: We included 26 studies reporting on 584 patients with SCS and 457 patients with NF adrenal tumors. Studies used different definitions of SCS. Patients with SCS undergoing adrenalectomy demonstrated an overall improvement in cardiovascular risk factors (61% for hypertension, 52% for diabetes mellitus, 45% for obesity and 24% for dyslipidemia). When compared with conservative management, patients with SCS undergoing adrenalectomy experienced improvement in hypertension (RR 11, 95% CI: 4.3-27.8) and diabetes mellitus (RR 3.9, 95% CI: 1.5-9.9), but not dyslipidemia (RR 2.6, 95% CI: 0.97-7.2) or obesity (RR 3.4,. Patients with NF adrenal tumors experienced improvement in hypertension (21/54 patients); however, insufficient data exist for comparison to patients with SCS. Conclusions: Available low-to-moderate-quality evidence from heterogeneous studies suggests a beneficial effect of adrenalectomy on cardiovascular risk factors in patients with SCS overall and compared with conservative management.

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“…[6][7][8] Although it has been well recognized that overt CS patients have a higher rate of mortality due to cardiovascular complications, such as myocardial infarction, congestive heart failure and stroke, 9,10 the cardiovascular prognosis of SCS remains undetermined. Several previous studies have shown the improvement of hypertension after surgical treatment in SCS; 8,[11][12][13] however, the outcome of other cardiovascular risk factors, such as diabetes, dyslipidemia and obesity, remains obscure. Because there have been no large studies on the cardiovascular prognosis in SCS, the clinical outcome achieved by surgical and medical management of SCS after long-term follow-up is open to debate.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcome of subclinical Cushing's syndrome after surgical and conservative treatment

et al. 2011

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Subclinical Cushing's syndrome (SCS), a subtle cortisol hypersecretion from an adrenal tumor, may be a common adrenal disease. However, the cardiovascular prognosis and the optimal surgical and conservative treatment in SCS remain elusive. The present study was undertaken to evaluate the prevalence of cardiovascular risk factors in 16 SCS cases, their relationships to cortisol secretory activities, and the clinical outcome after surgical and medical treatment. The prevalence of hypertension, impaired glucose tolerance (IGT), diabetes mellitus (DM), dyslipidemia and obesity in our SCS cases were 56%, 50%, 50%, and 19%, respectively, and 75% of cases were associated with two or more cardiovascular risk factors. In our series, 24-h urinary free-cortisol excretion showed a significant positive correlation with HbA1c and a negative correlation with high-density lipoprotein-cholesterol, but no correlation with age, body mass index, blood pressure or glycemic and lipid profile was found. Eight cases underwent unilateral adrenalectomy (operated (OP) group); the remaining eight cases were a conservative-treatment group (non-OP group). The number of cardiovascular risk factors decreased significantly in the OP group, but not in the non-OP group. In terms of differential changes in risk factors between the groups, more significant improvements of hypertension, dyslipidemia and IGT/DM were observed in the OP group than in the non-OP group. In conclusion, the present study showed the increased prevalence of cardiovascular risk factors in SCS patients with mild hypercortisolism related to impaired glucose/lipid metabolism. Adrenalectomy decreased accumulated cardiovascular risk factors in certain SCS patients, suggesting the possible involvement of mild hypercortisolism in the development of cardiovascular risk factors in SCS.

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Evaluation of the Cardiovascular Risk in Patients with Subclinical Cushing Syndrome Before and After Surgery

Abstract: These findings indicate that the increased incidence of cardiovascular risk factors commonly observed in classical CS, is also present in SCS. Unilateral adrenalectomy does not always lead to significant improvements in cardiovascular risk profile in SCS.

Cited by 98 publications

References 40 publications

Post-surgical hypocortisolism after removal of an adrenal incidentaloma: is it predictable by an accurate endocrinological work-up before surgery?

Post-surgical hypocortisolism after removal of an adrenal incidentaloma: is it predictable by an accurate endocrinological work-up before surgery?

THERAPY OF ENDOCRINE DISEASE: Improvement of cardiovascular risk factors after adrenalectomy in patients with adrenal tumors and subclinical Cushing’s syndrome: a systematic review and meta-analysis

Clinical outcome of subclinical Cushing's syndrome after surgical and conservative treatment

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