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Adrenalectomy Improves Muscle Strength in Patients with Mild Autonomous Cortisol Secretion: A Comparative Study.

İsmail Engin1, Mazhar Müslüm Tuna1

  • 1Department of Endocrinology and Metabolism, Health Sciences University Ümraniye Training and Research Hospital, Istanbul 34760, Turkey.

Medicina (Kaunas, Lithuania)
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Summary

Adrenalectomy significantly improves muscle strength in patients with mild autonomous cortisol secretion (MACS). Conservative management led to grip strength decline, highlighting surgery

Keywords:
MACSadrenal incidentalomaadrenalectomyhand grip strengthmild autonomous cortisol secretionmuscle strengthsarcopenia

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Area of Science:

  • Endocrinology
  • Surgical Oncology
  • Geriatrics

Background:

  • Mild autonomous cortisol secretion (MACS) is increasingly diagnosed in patients with adrenal incidentalomas.
  • MACS is linked to cardiometabolic risks, yet optimal management strategies, especially for functional outcomes, remain debated.
  • Current research lacks robust data on the impact of interventions on muscle strength in MACS patients.

Purpose of the Study:

  • To compare the effects of adrenalectomy versus conservative management on muscle strength in patients with MACS.
  • To evaluate functional outcomes, specifically hand grip strength and gait speed, following different management approaches for MACS.
  • To determine if surgical intervention improves objective muscle strength in parallel with biochemical resolution of cortisol excess.

Main Methods:

  • Retrospective comparative cohort study involving 40 patients diagnosed with MACS (1-mg dexamethasone suppression test > 1.8 µg/dL).
  • Fifteen patients underwent adrenalectomy, while 25 received conservative management.
  • Muscle strength was assessed using hand grip dynamometry and gait speed via the 1-m walk test at baseline and 6 months post-intervention.

Main Results:

  • The adrenalectomy group demonstrated significant improvements in both right (+1.19 kg) and left (+1.15 kg) hand grip strength at 6 months (p < 0.001), a ~5% increase.
  • Conversely, the conservative management group experienced significant decreases in grip strength over the same period (right: -0.40 kg, left: -0.28 kg; p < 0.001).
  • Biochemical markers of cortisol excess resolved post-adrenalectomy, with the 1-mg dexamethasone suppression test decreasing significantly (p < 0.001).

Conclusions:

  • Adrenalectomy leads to significant improvements in objective muscle strength among patients with MACS, correlating with successful biochemical management.
  • Conservative management of MACS was associated with a progressive decline in grip strength over a 6-month period.
  • Hand grip dynamometry is a valuable tool for assessing functional outcomes and may inform surgical decision-making in MACS management.