Adrenalectomy is underused: a call to reduce mortality

Area of Science:

• Endocrinology
• Surgical Oncology
• Public Health

Background:

• Adrenal tumors causing hormone excess, including primary aldosteronism, Cushing syndrome, and pheochromocytoma, result in significant mortality.
• Despite the lifesaving potential of adrenalectomy, surgical rates for these conditions remain suboptimal.
• Current screening protocols may not adequately identify all patients who would benefit from surgical intervention.

Purpose of the Study:

• To highlight the underutilization of adrenalectomy for hormone-excessive adrenal tumors.
• To estimate the potential mortality reduction achievable with optimized surgical rates.
• To advocate for urgent reforms in patient screening and surgical referral pathways.

Main Methods:

• Analysis of mortality data associated with adrenal tumors driving hormone excess.
• Comparative assessment of current adrenalectomy rates versus ideal rates in the USA, UK, and Sweden.
• Modeling of potential deaths averted through increased surgical intervention.

Main Results:

• Adrenalectomy is underused despite its proven efficacy in treating hormone-excessive adrenal tumors.
• Achieving ideal surgical rates in the USA, UK, and Sweden could prevent tens of thousands of deaths annually.
• The impact of increased adrenalectomy on mortality could rival that of major cancer operations.

Conclusions:

• Urgent reforms in screening and surgical referral are necessary to improve outcomes for patients with hormone-excessive adrenal tumors.
• Increased utilization of adrenalectomy represents a significant, yet largely untapped, public health intervention.
• Addressing the underuse of adrenalectomy can substantially reduce premature mortality from these endocrine disorders.