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Cardiovascular risk improvement after laparoscopic adrenalectomy in patients with cortisol-secreting adrenal adenoma,
Worapat Wonglhaw1, Apirak Santi-Ngamkun1, Supoj Ratchanon1
1Division of Urology, Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.
Insights
Laparoscopic adrenalectomy significantly improves cardiovascular risk factors in patients with cortisol-secreting adrenal tumors. Key factors like age, BMI, and blood pressure predict hypertension resolution.
Area of Science:
- Endocrinology
- Surgical Oncology
- Cardiovascular Medicine
Background:
- Cushing syndrome, primarily due to cortisol-secreting adrenal tumors, elevates cardiovascular morbidity and mortality.
- Unilateral laparoscopic adrenalectomy is a primary treatment for these tumors.
Purpose of the Study:
- To evaluate cardiovascular risk outcomes following adrenalectomy for cortisol-secreting adrenal tumors.
- To identify preoperative predictors for the resolution of hypertension, diabetes, and dyslipidemia.
Main Methods:
- Retrospective review of 45 patients undergoing unilateral laparoscopic adrenalectomy for cortisol-secreting adrenal tumors (2001-2022).
- Analysis of baseline parameters (age, BMI, tumor size) and postoperative evaluation of blood pressure, glucose, HbA1C, and lipid profiles.
- Statistical analysis to determine resolution rates and predictive factors for cardiovascular risk factors.
Main Results:
- Significant improvements in hypertension (P<0.001), dyslipidemia (P=0.01), and obesity (P=0.02) were observed within 3 months post-surgery.
- Diabetes mellitus (DM) showed significant improvement at 1 year (P<0.001).
- Predictive factors for hypertension resolution included younger age, lower BMI, and lower systolic blood pressure; preoperative serum cortisol predicted diabetes improvement, and serum cholesterol predicted dyslipidemia improvement.
Conclusions:
- Unilateral laparoscopic adrenalectomy is effective in improving cardiovascular risk factors in patients with cortisol-secreting adrenal adenomas.
- Preoperative clinical and biochemical parameters can predict the success of surgery in resolving these risk factors.
Background:
Cushing syndrome increases morbidity and mortality, which is mainly caused by cardiovascular disorders. This study reports the cardiovascular risk outcomes at 3, 6, and 12 months after unilateral laparoscopic adrenalectomy in cortisol-secreting adrenal tumor and to identify the preoperative parameters predicting the resolution of cardiovascular risk factors after surgery.
Methods:
All clinical data of patients with unilateral cortisol-secreting adrenal tumors who underwent laparoscopic adrenalectomy in King Chulalongkorn Memorial Hospital between 2001-2022 were retrospectively reviewed. Analyzed baseline parameters included age, gender, body mass index (BMI), tumor size, and laterality. Systolic and diastolic blood pressure (DBP), fasting blood sugar (FBS), hemoglobin A1C (HbA1C), lipid profiles, and serum cortisol level were evaluated before surgery and at 3, 6, 12 months postoperatively. The resolution rate and predictive factors of hypertension (HT), diabetes, and dyslipidemia after surgery were analyzed.
Results:
Forty-five patients were included in this study. The mean [standard deviation (SD)] age was 44.2 (14.7) years. The mean (SD) BMI was 25.9 (5.4) kg/m2. The mean (SD) tumor size was 3.1 (1.0) cm. Most of the patients were female (97.8%). After surgery, the resolution rate of HT, dyslipidemia, and obesity were significantly improved after 3 months (P<0.001, P=0.01, and 0.02 respectively). Diabetes mellitus (DM) significantly improved at 1 year after surgery (P<0.001). From multivariable analysis, the significant predictive factors for the resolution of HT were age [odds ratio (OR) 0.95; 95% confidence interval (CI): 0.91-0.99, P=0.01], BMI (OR 0.85; 95% CI: 0.77-0.95, P=0.003) and systolic blood pressure (SBP) (OR 0.97; 95% CI: 0.94-1, P=0.03). Preoperative serum cortisol was the significant predictive factor for the improvement of diabetes (OR 1.12; 95% CI: 1.01-1.25, P=0.04) and serum cholesterol was the predictive factor for the improvement of dyslipidemia (OR 0.97; 95% CI: 0.96-0.99, P=0.003) after surgery.
Conclusions:
Adrenalectomy significantly improves the cardiovascular risk factors in cortisol-secreting adrenal adenoma.
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