Cardiovascular risk improvement after laparoscopic adrenalectomy in patients with cortisol-secreting adrenal adenoma, a retrospective cohort study

Background: Cushing syndrome increases morbidity and mortality, which is mainly caused by cardiovascular disorders. This study reports the cardiovascular risk outcomes at 3, 6, and 12 months after unilateral laparoscopic adrenalectomy in cortisol-secreting adrenal tumor and to identify the preoperative parameters predicting the resolution of cardiovascular risk factors after surgery. Methods: All clinical data of patients with unilateral cortisol-secreting adrenal tumors who underwent laparoscopic adrenalectomy in King Chulalongkorn Memorial Hospital between 2001-2022 were retrospectively reviewed. Analyzed baseline parameters included age, gender, body mass index (BMI), tumor size, and laterality. Systolic and diastolic blood pressure (DBP), fasting blood sugar (FBS), hemoglobin A1C (HbA1C), lipid profiles, and serum cortisol level were evaluated before surgery and at 3, 6, 12 months postoperatively. The resolution rate and predictive factors of hypertension (HT), diabetes, and dyslipidemia after surgery were analyzed. Results: Forty-five patients were included in this study. The mean [standard deviation (SD)] age was 44.2 (14.7) years. The mean (SD) BMI was 25.9 (5.4) kg/m2. The mean (SD) tumor size was 3.1 (1.0) cm. Most of the patients were female (97.8%). After surgery, the resolution rate of HT, dyslipidemia, and obesity were significantly improved after 3 months (P<0.001, P=0.01, and 0.02 respectively). Diabetes mellitus (DM) significantly improved at 1 year after surgery (P<0.001). From multivariable analysis, the significant predictive factors for the resolution of HT were age [odds ratio (OR) 0.95; 95% confidence interval (CI): 0.91-0.99, P=0.01], BMI (OR 0.85; 95% CI: 0.77-0.95, P=0.003) and systolic blood pressure (SBP) (OR 0.97; 95% CI: 0.94-1, P=0.03). Preoperative serum cortisol was the significant predictive factor for the improvement of diabetes (OR 1.12; 95% CI: 1.01-1.25, P=0.04) and serum cholesterol was the predictive factor for the improvement of dyslipidemia (OR 0.97; 95% CI: 0.96-0.99, P=0.003) after surgery. Conclusions: Adrenalectomy significantly improves the cardiovascular risk factors in cortisol-secreting adrenal adenoma.