Daily Endocrinology Research Analysis
Two endocrine surgery cohorts refine risk–benefit discussions: unilateral adrenalectomy for primary aldosteronism frequently unmasks chronic kidney disease, and adrenalectomy for mild autonomous cortisol secretion is associated with postoperative weight loss predicted by low-dose dexamethasone suppression test cortisol. A small randomized trial suggests telmisartan may reduce inflammatory biomarkers versus other antihypertensives in diabetes and new-onset hypertension, though between-group diffe
Summary
Two endocrine surgery cohorts refine risk–benefit discussions: unilateral adrenalectomy for primary aldosteronism frequently unmasks chronic kidney disease, and adrenalectomy for mild autonomous cortisol secretion is associated with postoperative weight loss predicted by low-dose dexamethasone suppression test cortisol. A small randomized trial suggests telmisartan may reduce inflammatory biomarkers versus other antihypertensives in diabetes and new-onset hypertension, though between-group differences were not significant.
Research Themes
- Endocrine surgery outcomes and risk stratification
- Cortisol autonomy and metabolic sequelae
- Antihypertensive class effects on systemic inflammation in diabetes
Selected Articles
1. Renal function after adrenalectomy in patients with primary aldosteronism.
In a single-center retrospective cohort of 107 unilateral primary aldosteronism patients, eGFR declined in two-thirds at 12 months (median 20% decrease), and one-third of those with baseline eGFR ≥60 mL/min/1.73 m² fell below 60. Older age, lateralization index >30, and eGFR <60 at 1 month predicted persistent impairment.
Impact: Quantifies the magnitude and persistence of renal function decline after curative adrenalectomy, identifying practical risk factors for counseling and follow-up.
Clinical Implications: Counsel patients that eGFR may decline after adrenalectomy (unmasking CKD), especially in older patients or those with high lateralization index, and plan routine post-operative eGFR monitoring beyond 12 months.
Key Findings
- At 12 months post-adrenalectomy, 66% showed eGFR decline from baseline (median 20% decrease).
- Among patients with baseline eGFR ≥60, 32.5% dropped below 60 mL/min/1.73 m² at 12 months; recovery after a 1-month decline was rare.
- Older age, lateralization index >30, and eGFR <60 at 1 month were associated with eGFR <60 at 12 months.
Methodological Strengths
- Clear definition of renal endpoints and multiple postoperative time points up to 12 months.
- Use of adrenal venous sampling to confirm lateralization, reducing misclassification.
Limitations
- Retrospective, single-center design with incomplete long-term follow-up data availability.
- Limited adjustment for confounders (primarily univariate analyses).
Future Directions: Prospective multicenter studies should validate risk prediction (including lateralization index) and test renal-protective perioperative strategies in primary aldosteronism.
2. The impact of adrenalectomy on metabolic outcomes of patients with mild autonomous cortisol secretion defined by low-dose dexamethasone suppression testing.
In 65 unilateral adrenalectomy patients, those with mild autonomous cortisol secretion experienced greater postoperative weight improvement than those with nonfunctioning tumors. The 1-mg dexamethasone suppression test cortisol level independently predicted postoperative weight loss.
Impact: Provides evidence that biochemical MACS severity predicts weight benefit after adrenalectomy, informing surgical selection and patient counseling.
Clinical Implications: Consider adrenalectomy for MACS not only for cardiometabolic risk attenuation but also for potential weight loss, with 1-mg DST cortisol aiding patient selection.
Key Findings
- Among 65 patients (53 MACS, 12 nonfunctioning), MACS patients were more likely to achieve postoperative weight improvement (OR 8.31; P = .03).
- The 1-mg DST cortisol level independently predicted postoperative weight improvement after adjustment (OR 1.88; P = .04).
- MACS patients were older and more likely to have preoperative diabetes than nonfunctioning tumor patients.
Methodological Strengths
- Use of a standardized biochemical definition of MACS via 1-mg DST.
- Multivariable logistic regression to adjust for clinically relevant confounders.
Limitations
- Retrospective single-institution design with small nonfunctioning comparator group (n=12).
- Potential selection bias and residual confounding; metabolic outcomes other than weight showed mixed results.
Future Directions: Prospective randomized studies comparing surgery versus surveillance/medical therapy in MACS stratified by DST cortisol thresholds are needed to define indications and quantify metabolic benefits.
3. Anti-inflammatory potential of telmisartan compared to other antihypertensives: secondary outcomes from a randomized trial.
In 70 patients with T2DM and new hypertension, telmisartan produced larger within-group reductions in hsCRP, IL-6, and TNF-α over 12 weeks than comparator antihypertensives, but between-group differences were not statistically significant. Results suggest possible anti-inflammatory effects requiring confirmation in larger, blinded trials.
Impact: Provides randomized evidence addressing anti-inflammatory class effects among antihypertensives in a high cardiometabolic-risk group, with transparent registration and detailed biomarker reporting.
Clinical Implications: Do not preferentially select telmisartan solely for anti-inflammatory effects based on this study; consider it hypothesis-generating. If inflammation modulation is desired, telmisartan may be reasonable among ARBs pending confirmation in adequately powered trials.
Key Findings
- Within-group declines at 12 weeks were larger with telmisartan for hsCRP (3.4 to 1.8 mg/L), IL-6 (4.3 to 3.4 pg/mL), and TNF-α (19.4 to 13.8 pg/mL).
- Between-group differences at 12 weeks were not statistically significant for hsCRP (P=0.07), IL-6 (P=0.24), or TNF-α (P=0.93).
- Trial was randomized, open-label, active-controlled, and registered (CTRI/2023/04/051878).
Methodological Strengths
- Randomized, active-controlled design with prespecified biomarker assessments at baseline and 12 weeks.
- Trial registration and transparent reporting of medians and IQRs.
Limitations
- Open-label design and small sample size with heterogeneous comparator group (amlodipine, cilnidipine, ramipril).
- Inflammatory biomarkers were secondary outcomes; study underpowered for between-group differences.
Future Directions: Conduct adequately powered, blinded RCTs with uniform comparator and longer follow-up to test whether telmisartan confers clinically meaningful anti-inflammatory benefits in T2DM/HTN.