Long-term study of subclinical Cushing^|^rsquo;s syndrome shows high prevalence of extra-adrenal malignancy in patients with functioning bilateral adrenal tumors

Kawate, Hisaya; Kohno, Masanori; Matsuda, Yayoi; Akehi, Yuko; Tanabe, Makito; Horiuchi, Toshihiro; Ohnaka, Keizo; Nomura, Masatoshi; Yanase, Toshihiko; Takayanagi, Ryoichi

doi:10.1507/endocrj.ej14-0155

Cited by 16 publications

(13 citation statements)

References 40 publications

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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%

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

142

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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Section: Characteristics Of Included Studiesmentioning

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

142

110

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“…We have performed a follow-up survey for patients with adrenal tumors treated at Kyushu University Hospital [21]. This study protocol was approved by the Kyushu University Institutional Review Board for Clinical Research (protocol number; 26-98).…”

Section: Ethical Considerationmentioning

confidence: 99%

Eplerenone improves carotid intima-media thickness (IMT) in patients with primary aldosteronism

et al. 2016

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PRIMARY ALDOSTERONISM (PA) is characterized by excessive secretion of the mineralocorticoid hormone aldosterone and is frequently caused by an aldosterone-secreting adrenocortical adenoma or adrenal hyperplasia [1,2]. PA is the most frequent form of secondary hypertension and has been estimated to affect 5-15% of hypertensive patients [3][4][5]. Moreover, the prevalence of PA has been found to correlate with the severity of hypertension [6,7], and patients with PA are at higher risk for cardiovascular events than those with essential hypertension [8][9][10] Abstract. Primary aldosteronism (PA) is associated with a higher rate of cardiovascular events than essential hypertension. Although adrenalectomy has been reported to reduce carotid intima-media thickness (IMT) in patients with PA, the effects of the selective aldosterone blocker, eplerenone, on vascular damage in these patients remains unclear. To evaluate the effects of eplerenone on vascular status in PA patients, we sequentially measured carotid IMT (using computer software to calculate an average IMT for accurate and reproducible evaluation) in 22 patients including 8 patients treated by unilateral adrenalectomy and 14 patients treated with eplerenone for 12 months. Patients who underwent adrenalectomy showed significant reductions in aldosterone concentration (from 345 ± 176 pg/mL to 67 ± 34 pg/mL; P<0.01) and IMT (from 0.67 ± 0.07 mm to 0.63 ± 0.09 mm; P<0.05) 6 months after surgery. Patients treated with eplerenone showed significant reductions in IMT from baseline (0.75 ± 0.10 mm) to 6 (0.71 ± 0.11 mm; P<0.05) and 12 (0.65 ± 0.09 mm; P<0.01) months, although plasma aldosterone level increased significantly, from 141 ± 105 pg/mL to 207 ± 98 pg/mL (P<0.05). Eplerenone treatment of patients with PA reduces blood pressure, increases serum potassium level, and improves vascular status. Carotid IMT may be a useful marker for evaluating the effectiveness of eplerenone in patients with PA.

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“…found 3 (11%), 2 (22%) and 1 (5%) cases of subclinical hypercortisolism with PRKACA mutations, respectively. Long‐term follow‐up studies showed a small number of cases of progressive subclinical hypercortisolism and even development of malignancy . Subclinical Cushing's syndrome is not an early stage in the development of overt hypercortisolism .…”

Section: Discussionmentioning

confidence: 99%

“…Longterm follow-up studies showed a small number of cases of progressive subclinical hypercortisolism and even development of malignancy. [18][19][20] Subclinical Cushing's syndrome is not an early stage in the development of overt hypercortisolism. 7,21,22 However, previous and current studies suggest that the PRKACA mutation is not accidental in subclinical Cushing's syndrome.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics of PRKACA mutations in Chinese patients with adrenal lesions: a single‐centre study

Wang

Tang

et al. 2016

Clinical Endocrinology

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Long-term study of subclinical Cushing^|^rsquo;s syndrome shows high prevalence of extra-adrenal malignancy in patients with functioning bilateral adrenal tumors

Cited by 16 publications

References 40 publications

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

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

Eplerenone improves carotid intima-media thickness (IMT) in patients with primary aldosteronism

Clinical characteristics of PRKACA mutations in Chinese patients with adrenal lesions: a single‐centre study

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