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송기호Keeho Song

건국대학교 의과대학

Ann. Surg., Dec 21 2023, | https://doi.org/10.1097/SLA.0000000000006183 Adrenalectomy Improves Body Weight, Glucose, and Blood Pressure Control in Patients with Mild Autonomous Cortisol Secretion: Results of an RCT by the Co-work of Adrenal Research (COAR) Study

Koh, Jung-Min MD^*; Song, Keeho MD^†; Kwak, Mi Kyung MD^‡; Suh, Sunghwan MD^§; Kim, Beom-Jun MD^*; Sung, Tae-Yon MD^∥; Hong, Jun Hyuk MD^¶; Jeong, Byong Chang MD^#; Kim, Jae Hyeon MD^**; Lee, Seung Hun MD^*

^*Division of Endocrinology and Metabolism, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

^†Division of Endocrinology and Metabolism, Department of Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea

^‡Division of Endocrinology and Metabolism, Hallym University Dongtan Sacred Heart Hospital, Dongtan, Korea

^§Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea

^∥Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul Korea

^¶Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

^#Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

^**Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

J-MK and KS are joint first authors.

JHK and SHL are the corresponding authors.

Abstract

Objective: To assess the metabolic effects of adrenalectomy in patients with mild autonomous cortisol secretion (MACS).

Background: Despite retrospective studies showing the association of adrenalectomy for MACS with beneficial metabolic effects, there have been only two randomized prospective studies with some limitations to date.

Methods: A prospective, multicenter study randomized 132 patients with adrenal incidentaloma without any features of Cushing's syndrome but with serum cortisol>50 nmol/L after a 1 mg overnight dexamethasone suppression test (F-1mgODST) into an adrenalectomy group (n=66) or control group (n=66). The primary outcomes were changes in body weight, glucose, and blood pressure (BP).

Results: Among the 118 participants who completed the study with a median follow-up duration of 48 months (range: 3-66), the adrenalectomy group (n=46) exhibited a significantly higher frequency of improved weight control, glucose control, and BP control (32.6%, 45.7%, and 45.7%, respectively) compared to the control group (n=46; 6.5%, P=0.002; 15.2%, P=0.002; and 23.9%, P=0.029, respectively) after matching for age and sex. Adrenalectomy (odds ratio [OR]=10.38, 95% confidence interval [95% CI]=2.09-51.52, P=0.004), body mass index (OR=1.39, 95% CI=1.08-1.79, P=0.010), and F-1mgODST levels (OR=92.21, 95% CI=5.30-1604.07, P=0.002) were identified as independent factors associated with improved weight control. Adrenalectomy (OR=5.30, 95% CI=1.63-17.25, P=0.006) and diabetes (OR=8.05, 95% CI=2.34-27.65, P=0.001) were independently associated with improved glucose control. Adrenalectomy (OR=2.27, 95% CI=0.87-5.94, P=0.095) and hypertension (OR=10.77, 95% CI=3.65-31.81, P<0.001) demonstrated associations with improved BP control.

Conclusions: Adrenalectomy improved weight, glucose, and BP control in patients with MACS.

논문정보

형식Research article
게재일2023년 12월 (BRIC 등록일 2023-12-27)
연구진국내 연구진
분야 의약학 > 의약학 기타

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