Adrenalectomy improves cardiovascular profile in patients with mild autonomous cortisol secretion: extension of a multicenter randomized controlled trial to 12 months

Purpose: The best therapeutic approach in patients with mild autonomous cortisol secretion (MACS) is debated. In this extension of a randomized controlled trial to 12 months we aimed to evaluate the effect of adrenalectomy on blood pressure, cardiac structure and coagulation factors in outpatients with MACS. Methods: patients with unilateral adrenal incidentaloma ≥ 1 cm and cortisol after 1 mg dexamethasone suppression test (F-1mgDST) between 1.8 (50 nmol/L) and 5 µg/dL (138 nmol/L) were enrolled and randomized to adrenalectomy (Arm-A) or conservative approach (Arm-B). Blood pressure control, echocardiographic indices and coagulation factors, were assessed at baseline and 12 months after recovery or observation, in Arm-A and Arm-B, respectively. Results: 51 subjects (23/28 in Arm-A/Arm-B) were enrolled. At follow-up the prevalence of blood pressure improvement was higher in Arm-A (10/23 patients, 43.5%) than in Arm-B patients (4/28 patients, 14.3%, p = 0.02). The improvement of blood pressure control was 5.4-fold more frequent in Arm-A patients (CI, 1.16–24.9 p = 0.03), regardless of confounding factors. In Arm-A, left ventricular mass, left atrial area and the prevalence of left atrial dilatation decreased at follow-up (96.4 ± 28.8 vs 87.6 ± 25,6 g/m2, p = 0.02; 28.4 ± 9.9 vs 22.6 ± 12.4 cm2, p = 0.04, 70.6% vs 35.3% p = 0.04, respectively) whereas all these parameters remained stable in Arm-B. At the end of follow-up, Arm-A patients had a lower prevalence of altered anti-coagulant parameters than Arm-B patients (2/19 patients, 10.5% vs 13/24 patients 54.2%, respectively, p = 0.002). Conclusion: In patients with MACS, surgery ameliorates blood pressure, cardiac structure, and coagulation factors. Trial registration: NCT number 04860180.