Outcomes of Adrenalectomy in adrenal incidentalomas with subclinical Cushing's syndrome.

Purpose: Adrenalectomy represents the definitive treatment in clinically evident Cushing's Syndrome, while the most appropriate treatment in case of subclinical Cushing's Syndrome (SCS) in adrenal incidentalomas remains controversial. This study was aimed to compare the outcome of adrenalectomy or conservative management in adrenal incidentalomas with SCS. Methods: Twenty patients underwent laparoscopic adrenalectomy for SCS in adrenal incidentaloma, while 15 were managed conservatively. Hormonal laboratory parameters of corticosteroidal secretion, arterial blood pressure (BP), glycometabolic control parameters, and quality of life (by the SF-36 questionnaire) were assessed pre and postoperatively. Results: The 2 groups were equivalent concerning demographics, preoperative laboratory data, BP levels. In the surgical group, no postoperative morbidity occurred; laboratory corticosteroidal parameters normalized in all patientswhile never in the conservative group (p<0.01). In operated patients, a normalization or significant amelioration of BP was achieved in 53% and glucose intolerance recovered in 54% of cases; while in the conservative group no significant ameliorations or some worsening occurred (p<0.01). SF-36 physical and mental components significantly ameliorated in the surgical group (p<0.01). Conclusions: Adrenalectomy can be more beneficial than conservative management in SCS. Surgery may achieve remission of laboratory hormonal abnormalities, improve BP values, glycemic control, and quality of life.