Effect of surgical versus conservative management on cardiovascular outcomes in patients with bilateral adrenal tumours and cortisol excess: an international, retrospective cohort study
Authors' conclusion
Although mortality and cardiovascular event rates were similar across treatments, surgery led to better biochemical control and more favourable comorbidity outcomes.
Study context
- Population
- Patients with bilateral adrenal tumours ≥10 mm, post-dexamethasone cortisol ≥50 nmol/L and ≥36 months follow-up; median age 62 years, 68% female
- Participants
- 629 patients
- Exposure
- Surgical vs conservative management by diagnosis
- Cushing's syndromen = 105
- Mild autonomous cortisol secretion (MACS)n = 524
- Outcome
- All-cause mortality and clinical and biochemical remission rates
- Follow-up
- Median 6.8 years
Methodological detailsinternational, multicentre (30 centres, 10 countries in Europe plus Singapore and the USA), 85 (81%) of 105 patients with CS underwent surgery; 384 (73%) of 524 with MACS received non-specific symptomatic treatment only
- International
- Multicentre (30 centres, 10 countries in Europe plus Singapore and the USA)
- 85 (81%) of 105 patients with CS underwent surgery; 384 (73%) of 524 with MACS received non-specific symptomatic treatment only
Main finding
As reported in the abstract
| Group | Value | Biochemical remission denominator | Deaths |
|---|---|---|---|
| Cushing's syndrome | 45% | 102 | seven of 105 (7%) |
| MACS | 13% | 517 | 38 of 524 (7%) |
Value
Cushing's syndrome45%
MACS13%
Biochemical remission denominator
Cushing's syndrome102
MACS517
Deaths
Cushing's syndromeseven of 105 (7%)
MACS38 of 524 (7%)
Observational data: associations, not effects.
Secondary outcomes
≥1 cardiovascular event · median follow-up 6.8 years
≥1 cardiovascular event · median follow-up 6.8 years
- No substantial differences across treatments
Comorbidities
- Bilateral adrenalectomy improved arterial hypertension
- Unilateral adrenalectomy and steroidogenesis inhibitors: no substantial comorbidity improvement
- Non-specific symptomatic treatment in MACS associated with worsening of all investigated comorbidities
Safety
- Bilateral adrenalectomy led to few non-fatal adrenal crises
Original publication
Effect of surgical versus conservative management on cardiovascular outcomes in patients with bilateral adrenal tumours and cortisol excess: an international, retrospective cohort study. Lancet Diabetes Endocrinol. Published 21 January 2026. doi:10.
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