TOPLINE:

In patients with mild autonomous cortisol secretion (MACS), adrenalectomy led to significant improvements in blood pressure (BP) control, cardiac structure, and coagulation parameters at 12 months. Surgery was associated with a more than fivefold higher likelihood of BP improvement than conservative management.

METHODOLOGY:

• Researchers in Italy conducted an extension of a multicentre randomised controlled trial to assess the effect of adrenalectomy on BP, cardiac structure, and coagulation indices in patients with MACS and unilateral adrenal tumour over a follow-up duration of 12 months.
• They analysed data of 51 patients with unilateral adrenal incidentaloma of at least 1 cm and serum cortisol levels between 50 and 138 nmol/L following the 1 mg dexamethasone suppression test; patients had been randomly assigned to either the adrenalectomy group (n = 23; mean age, 61.9 years) or the conservative management group (n = 28; mean age, 65.9 years).
• The study's primary endpoint was the comparison of changes in BP control (improvement or worsening) between surgery and conservative management groups. Secondary outcomes included changes in echocardiographic and coagulation parameters.

TAKEAWAY:

• At 12 months, BP improvement was more frequent with surgery vs conservative management (43.5% vs 14.3%; P = .02).
• Patients undergoing adrenalectomy were 5.4-fold more likely to experience improvement in BP control than those receiving conservative management (P = .03).
• In the adrenalectomy group, the left ventricular mass index decreased from 96.4 to 87.6 g/m², the left atrial area decreased from 28.4 to 22.5 cm², and the prevalence of left atrial dilation dropped from 70.6% to 35.3% (P < .05 for all). All these parameters remained unchanged in the conservative management group.
• Patients in the adrenalectomy group had a lower prevalence of altered coagulation parameters than those in the conservative management group (36.8% vs 70.8%; P = .03), especially for anticoagulant pattern alterations (10.5% vs 54.2%; P = .002).

IN PRACTICE:

"[The study] results support the view that surgery may be an effective strategy for reducing CV [cardiovascular] risk in selected MACS patients, particularly those with cortisol-related comorbidities, whereas conservative management may be associated with worsening hemodynamic profile," the authors wrote.

SOURCE:

This study was led by Valentina Morelli, Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano, IRCCS, Milan, Italy. It was published online on April 06, 2026, in the Journal of Endocrinological Investigation.

LIMITATIONS:

The limited number of patients who completed the entire follow-up may have concealed some important findings. Some data were available only in subgroups of patients due to COVID-19 pandemic restrictions. Medical treatments among conservatively managed patients were not standardised, potentially introducing a bias.

DISCLOSURES:

This study received support from the Italian Ministry of Health — Ricerca Corrente. Some authors declared serving as investigators of studies on relacorilant by Corcept Therapeutics for patients with hypercortisolism and/or declared receiving consulting fees from various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.