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.
BACKGROUND: Although adrenalectomy is recommended for unilateral primary aldosteronism, the postoperative effects on renal function remain poorly understood. We evaluated renal function after adrenalectomy and identified risk factors for function decline. METHODS: A single-institution retrospective study included adults undergoing adrenalectomy (2002-2024) for unilateral primary aldosteronism on the basis of adrenal venous sampling. Estimated glomerular filtration rate (eGFR)% change was defined as ([baseline eGFR - postoperative eGFR]/baseline eGFR) × 100. Univariate logistic regression assessed estimated glomerular filtration rate decline <60 mL/min/1.73 m² at 12 months. RESULTS: Of 107 patients, the median age was 55 years and 92 (86%) had baseline eGFR ≥60 mL/min/1.73 m² before surgery. eGFR levels were available for 87 patients on postoperative day 1, 64 at 1 month, 43 at 6 months and 47 at 12 months, and eGFR declined from baseline in 37%, 58%, 74% and 66%, respectively. Median eGFR% decline was 13% on postoperative day 1, 18.2% at 1 month, 20.5% at 6 months and 20% at 12 months. One of 15 patients with baseline eGFR <60 required dialysis 3 months postoperatively. Among 92 patients with baseline eGFR ≥60, eGFR dropped <60 in 26% and 32.5% at 1 and 12 months, respectively. After eGFR decline <60 at 1 month, only 1 patient experienced recovery. Variables associated with eGFR decline <60 at 12 months were older age, lateralization index >30, and 1 month eGFR decline <60. CONCLUSION: After adrenalectomy for unilateral primary aldosteronism, a significant decrease in estimated glomerular filtration rate was observed. Patients should be counseled on the high likelihood of unmasked renal impairment after adrenalectomy and estimated glomerular filtration rate monitoring is recommended for all patients.
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.
BACKGROUND: Up to 50% of patients with adrenal incidentalomas have mild autonomous cortisol secretion, which may increase their cardiometabolic morbidity, compared with patients with nonfunctional adrenal tumors. Studies evaluating cardiometabolic outcomes of patients with mild autonomous cortisol secretion defined by 1-mg dexamethasone suppression testing (cortisol 1.8-5 μg/dL) have demonstrated mixed results. The aim of this study was to assess the metabolic outcomes of patients with mild autonomous cortisol secretion, defined by the 1-mg dexamethasone suppression testing criterion, compared with patients with nonfunctional adrenal tumors who underwent adrenalectomy. METHODS: We conducted a single-institution retrospective cohort study comparing adult patients who underwent unilateral adrenalectomy from November 30, 2011, to August 19, 2023, for mild autonomous cortisol secretion (1-mg dexamethasone suppression testing cortisol 1.8-5 μg/dL) or nonfunctional adrenal tumors (1-mg dexamethasone suppression testing cortisol <1.8 μg/dL). Preoperative prevalences and postoperative changes in diabetes mellitus, hypertension, dyslipidemia, and elevated body mass index (≥25) were assessed. Patients were followed from the time of surgery until their last outpatient visit. Multivariable logistic regression was pursued for outcomes that varied between cohorts. RESULTS: A total of 65 patients (53 mild autonomous cortisol secretion and 12 nonfunctional adrenal tumors) were analyzed. Patients with mild autonomous cortisol secretion were older and more likely to have diabetes mellitus than patients with nonfunctional adrenal tumors (odds ratio: 7.81, 95% confidence interval [0.94, 64.96], P = .04). Patients were followed for a median of 28.1 months [11.1, 55.3 months]. Patients with mild autonomous cortisol secretion were more likely to have postoperative weight improvement (odds ratio: 8.31, [0.97, 71.14], P = .03). After adjusting for clinically relevant variables, the 1-mg dexamethasone suppression testing cortisol was predictive of postoperative weight improvement (odds ratio: 1.88, [1.1, 3.65], P = .04). CONCLUSION: Weight loss should be considered as a potential benefit of adrenalectomy in patients with mild autonomous cortisol secretion.
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.
BACKGROUND: Chronic low-grade inflammation plays a central role in the pathophysiology of both type 2 diabetes mellitus (T2DM) and hypertension, contributing to increased cardiovascular risk. Telmisartan, an angiotensin receptor blocker with partial peroxisome proliferator-activated receptor gamma (PPAR-γ) agonist activity, may offer anti-inflammatory benefits in addition to its antihypertensive effects. AIMS: This study compares the effects of telmisartan versus other standard antihypertensive agents on inflammatory biomarkers, including high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), and tumour necrosis factor-alpha (TNF-α), in patients with diabetes and newly diagnosed hypertension. METHODS: This is a randomized, open-label, parallel-group, active-controlled trial. Seventy eligible patients were randomized to receive telmisartan (N = 34) or another antihypertensive agent [amlodipine (n = 22), cilnidipine (n = 12), or ramipril (n = 2)] (N = 36). Secondary outcome parameters included inflammatory biomarkers such as highly sensitive C-reactive protein (hsCRP), interleukin-6 (IL-6), and tumour necrosis factor alpha (TNF-α) measured at baseline and 12 weeks following treatment. Data are presented as median and interquartile range (IQR). Between-group comparisons at 12 weeks were performed using the Mann-Whitney U test. The trial is registered with the Clinical Trial Registry of India (CTRI/2023/04/051878). RESULTS: At baseline, hsCRP, IL-6, and TNF-α levels were comparable between groups. In the telmisartan group, hsCRP declined from 3.4 mg/L (IQR: 2.0, 13.7) to 1.8 mg/L (IQR: 1.2, 5.0), IL-6 from 4.3 pg/mL (IQR: 2.9,9.5) to 3.4 pg/ml (IQR: 2.2, 6.8), and TNF-α from 19.4 pg/ml (IQR: 8.9, 43.7) to 13.8 pg/ml (IQR: 3.5, 32.4). In the active control group, hsCRP changed from 3.1 mg/L (IQR: 1.7, 8.0) to 2.9 mg/L (IQR: 1.7, 4.9), IL-6 from 4.1 pg/ml (IQR: 3.0,7.6) to 4.2 pg/ml (IQR: 2.9, 7.8), and TNF-α from 20.2 pg/ml (IQR: 10.4, 48.6) to 16.9 pg/ml (IQR: 3.3, 30.3). The differences between groups at 12 weeks were not statistically significant for hsCRP (P = 0.07), IL-6 (P = 0.24), or TNF-α (P = 0.93). CONCLUSION: The anti-inflammatory markers were reduced in both groups at 12 weeks without any statistically significant difference across groups. However, telmisartan was associated with greater reductions in hsCRP, IL-6, and TNF-α in patients with T2DM and hypertension following 12 weeks of treatment. These findings may indicate a potential anti-inflammatory effect of telmisartan that requires confirmation in adequately powered trials.