25 METABOLIC IMPACT OF ADRENAL SURGERY IN PATIENTS WITH ADRENAL INCIDENTALOMA CAUSING BIOCHEMICAL HYPERCORTISOLISM

Abstract

You have accessJournal of UrologyAdrenal: Surgery/Tumors/Benign and Malignant Disease1 Apr 201125 METABOLIC IMPACT OF ADRENAL SURGERY IN PATIENTS WITH ADRENAL INCIDENTALOMA CAUSING BIOCHEMICAL HYPERCORTISOLISM Jerome Vandwalle, Ludovic Viart, Salah Fendri, Jacques Petit, Rachel Dessailloud, and Fabien Saint Jerome VandwalleJerome Vandwalle Amiens, France More articles by this author , Ludovic ViartLudovic Viart Amiens, France More articles by this author , Salah FendriSalah Fendri Amiens, France More articles by this author , Jacques PetitJacques Petit Amiens, France More articles by this author , Rachel DessailloudRachel Dessailloud Amiens, France More articles by this author , and Fabien SaintFabien Saint Amiens, France More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.087AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In patients with adrenal incidentalomas, subclinical hypercortisoolism is associated with increased prevalence of the metabolic syndrome. The objective of the study was to determine the effect of the surgical approach on the metabolic syndrome (body weight, blood pressure, glucose level) in patients with adrenal incidentaloma and biochemical hypercortisolism, 3, 6 and 12 months after surgery. METHODS From 2003 to 2009, adrenal surgery was performed for 114 patients. 21 were performed for incidentalomas with biochemical hypercortisolism. Hypercortisolism was diagnosed in the presence of one or more of the following: urinary free cortisol/24H, cortisol after 1 mg dexamethasone (DXM) suppression test, ACTH level. Metabolic parameter's improvement/worsening (body mass index (BMI), blood pressure, fasting glucose and HbA1c levels) were studied for all patients, 3, 6 and 12 months after surgery. RESULTS From the 21 patients before surgery, 56% had been treated for high blood pressure, 29% for diabetes, 38% for obesity. Mean age was 55.6 years (35–75). There were 5 men and 16 women. Mean BMI was 26.9 (20–375). 100% patients had shown high urinary free cortisol, 86% DXM negative test and 68% low ACTH levels. 100% patients had shown at least two abnormal biochemical tests and 63% more than two. Surgery was performed using laparoscopic approach for 16 patients and by laparotomy for 5. Mean operative time was 109 mn (185-60). After one year follow-up: For hypertensive patients, 77% have been improved (18% stopped or decreased hypertensive medications); for diabetic patients, 66% improved their diabetes (33% stopped or decreased diabetes medications and 66% improved fasting glucose and their HbA1c levels; for obese patients, 77% improved body mass index with a mean weight loss of 2.3 kg/m2 (0.5–5). Best results on BMI and blood pressure have been shown in youngest patients (p=0.01; p=NS). Best results on obesity have been shown in highest BMI (p=0.01). CONCLUSIONS Surgical treatment appears to be useful for incidentalomas with biochemical hypercortisolism, particularly for youngest and obese patients. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e9 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jerome Vandwalle Amiens, France More articles by this author Ludovic Viart Amiens, France More articles by this author Salah Fendri Amiens, France More articles by this author Jacques Petit Amiens, France More articles by this author Rachel Dessailloud Amiens, France More articles by this author Fabien Saint Amiens, France More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...