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EFFECTIVENESS OF UNILATERAL ADRENALECTOMY IN BILATERAL ADRENAL INCIDENTALOMA PATIENTS WITH SUBCLINICAL
N Yilmaz1, G Tazegul2, R Sari1
1Division of Endocrinology, Akdeniz University, School of Medicine, Antalya, Turkey.
Acta Endocrinologica (Bucharest, Romania : 2005)
|June 24, 2022
Summary
Unilateral adrenalectomy effectively treats bilateral adrenal incidentaloma with subclinical hypercortisolemia, leading to high remission rates and reduced cortisol levels. This surgical approach offers a viable alternative to bilateral adrenalectomy, minimizing long-term risks.
Area of Science:
- Endocrinology
- Surgical Oncology
Background:
- Bilateral adrenal incidentaloma (AI) presents a treatment challenge, with bilateral adrenalectomy carrying long-term risks.
- Subclinical hypercortisolemia (SH) in AI patients requires effective management strategies.
Purpose of the Study:
- To evaluate the effectiveness of unilateral adrenalectomy (UA) in treating bilateral AI patients with SH.
- To compare outcomes between patients undergoing UA and those managed conservatively.
Main Methods:
- Retrospective analysis of 35 patients with bilateral AI and SH.
- Patients were divided into UA group (n=27) and patients without adrenalectomy (PWA) group (n=8).
- Hormone levels (cortisol, ACTH) were reviewed pre- and post-treatment/follow-up, including dexamethasone suppression tests (DST).
Main Results:
- The UA group showed a 92.6% remission rate for SH, significantly lower final cortisol levels post-dexamethasone suppression (p=0.003), and higher final ACTH levels (p=0.001) compared to the PWA group.
- In the UA group, final basal cortisol (p=0.009) and post-1mg DST cortisol (p=0.004) were lower than at diagnosis.
- No patients in the PWA group recovered from hypercortisolemia during follow-up.
Conclusions:
- Unilateral adrenalectomy targeting the larger lesion is an effective treatment for bilateral AI with SH.
- UA successfully reduces excess cortisol levels and achieves high remission rates, offering an alternative to bilateral adrenalectomy.
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