Comparison Of Adrenalectomy Versus Conservative Management On Metabolic Outcomes In Patient With Adrenal Incidentalomas And Subclinical Cushing's Syndrome:A Meta-analysis

Objective: The metabolic outcomes of adrenal incidentalomas(AI)with subclinical Cushing's syndrome(SCS)in the treatment of adrenalectomy versus conservative management were been analyzed by the means of evidence-based medicine.Methods: We searched Pubmed,Embase,and The Cochrane Library database to identify relevant studies of clinical trials,which compared the effect of adrenalectomy and conservative management on metabolic outcomes in patient with AI and SCS published before December 2018.The selected research studies were performed with Revman 5.1 software for meta-analysis.The main content of the analysis was the metabolic results of each group,including blood pressure,blood glucose,blood lipids and body weight.Results: 11 studies were included,involving 525 patients(287 in the surgical group and 238 in the conservative management group).The results of meta-analysis showed that the patients in the surgical group,the hypertension(OR=26.93,95%CI: 7.95,91.27,P<0.00001),diabetes / impaired fasting blood glucose(OR=10.79,95%CI: 2.99,39.01,P=0.0003),dyslipidemia(OR=4.55,95%CI: 1.31,15.84,P=0.02)got higher improvement rates than those in the conservative management group,and there were statistically significant differences between two groups;the change in systolic blood pressure(MD=-11.66 mm Hg,95%CI: 18.10,-5.22,P=0.0004),diastolic blood pressure(MD=-7.37 mm Hg,95%CI:-10.37,-4.36,P<0.00001),fasting blood glucose(SMD=-0.89mg/dl,95%CI:-1.36,-0.43,P=0.0002),body mass index(MD=-1.70Kg/m2,95%CI:-2.3,-1.02,P<0.00001),and triglycerides(MD=-21.16mg/dl,95%CI:-29.45,-12.87,P<0.00001)in the patients who underwent adrenalectomy got bigger changes than those in the conservative management group,and there were statistically significant differences between two groups.Conclusions: For patients with AI and SCS,adrenalectomy can get more beneficial effects on improvement rate in hypertension,diabetes / impaired fasting blood glucose,dyslipidemia,and change in systolic blood pressure,diastolic blood pressure,fasting blood glucose,body mass index,triglycerides.However,further high quality and large-scale randomized controlled trials are needed to confirm these findings.