Long-term cardiac effects of adrenalectomy versus surveillance in mild cortisol excess: 5-year results from the prospective ITACA study
Authors' conclusion
MACS is associated with early concentric LV remodelling that regresses after adrenalectomy but rebounds within 5 years, leaving surgical and surveillance patients with comparable cardiac geometry. Under AS, remodelling stabilizes, whereas NFA continue a slow, progressive hypertrophic course. These findings support serial echocardiographic monitoring and underscore the need to test other cortisol-lowering therapies, alone or in combination with surgery, for durable cardioprotection.
Study context
- Population
- Patients with mild autonomous cortisol secretion (MACS) or non-functioning adrenal incidentalomas (NFAI); clinical, biochemical and echocardiographic evaluations at baseline, 1 and 5 years35 MACS, 25 NFAI
- Participants
- 60 patients
- Exposure
- MACS managed by adrenalectomy vs active surveillance, and NFAI
- MACS-ADRXn = 13
- MACS-ASn = 22
- NFAIn = 25reference
- Outcome
- Reversibility of MACS-associated cardiac remodelling after treatment and trajectories vs NFAI
Methodological detailsfive-year follow-up
- Five-year follow-up
Main finding
As reported in the abstract
LV mass index (LVMi) change at 1 year, MACS-ADRX
−14.8 g/m²
95%CI −28.7 to −0.9
LVMi change at 1 year, MACS-AS
13.7 g/m²
0.8 to 26.5
LVMi change at 5 years, NFAI
22.4 g/m²
12.3 to 32.5P < .001
Observational data: associations, not effects.
Further findings
| Outcome | NFAI | P value |
|---|---|---|
| Baseline LV hypertrophyMACS vs NFAI | 16% | P = 0.013 |
| Baseline diastolic dysfunctionMACS vs NFAI | 12% | P = 0.050 |
| Baseline LVMiMACS vs NFAI | median 85 g/m² | P = 0.011 |
- Baseline left-ventricular (LV) hypertrophy: MACS 46%
- Baseline diastolic dysfunction: MACS 34%
- Baseline LVMi: MACS median 100 g/m²
Right-ventricular systolic excursion (TAPSE)
- TAPSE improved only in MACS-AS
- 3.6 mm, 1.8 to 5.4; P = .001
Global LV systolic and diastolic indices
- Deteriorated similarly across groups
Safety
MACE
Original publication
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