[Long-term consequences of surgical excision of cortisol producing adrenocortical adenoma].

INTRODUCTION Surgical excision of adrenocortical tumour in patients with ACTH-independent Cushing syndrome gives a chance for their entire cure. However in some patients after adrenalectomy persistent arterial hypertension, obesity and diabetes mellitus is observed. The aim of the study was to analyse long term consequences of surgical excision of cortisol producing adrenocortical adenoma with a special attention on the influence of adrenalectomy on arterial blood pressure. MATERIAL AND METHODS 15 patients (mean age 54 years) suffering from arterial hypertension (n = 15), obesity or overweight (n = 12) and diabetes mellitus (n = 7) were subjected to analysis. Mean follow up time was 45 months. RESULTS Improvement of blood pressure control after unilateral adrenalectomy was observed in 66.7% of patients. The risk factor of no improvement of blood pressure control was BMI > 30.5 kg/m(2) (RR = 4.0 [1.07-14.90]). During the follow up period decrease of maximal values of systolic and diastolic blood pressure was observed (34 [17-50] and 25 [16-35] mm Hg respectively; p < 0.01). In the entire group of patients a 3.4 kg/m(2) decrease of BMI was observed p = 0.01. BMI decreased significantly (more than 1 kg/m(2)) in 66.7% of patients. Only in 2 patients a complete regression of diabetes was observed. 46.7% of patients required supplementation with adrenal steroids. 40% of patients reported a subjective withdrawal of all symptoms of the disease after surgery and 46.7% only partial remission. CONCLUSION Surgical excision of cortisol producing adrenocortical adenoma results in improvement of blood pressure control and body weight reduction in a large percentage of patients with Cushing syndrome. Obesity before adrenalectomy is the factor that reduces a chance for improvement of blood pressure control after surgery.