Metabolic outcomes in ACTH-independent hypercortisolism: medical therapy vs. adrenalectomy in a monocentric retrospective study

Excessive cortisol secretion is responsible for metabolic complications, increasing morbidity and mortality. Normalizing cortisol levels with surgery or medical treatments are the most effective ways to limit these complications, but few studies have compared these two strategies specifically on metabolic complications. This observational, retrospective, monocentric study included 62 patients with confirmed endogenous ACTH-independent hypercortisolism followed in our department between January 2019 and January 2024. Patients were included in three groups: surgery ( n = 42), medication ( n = 13), and observation ( n = 7). Metabolic complications were assessed at baseline, 6 months and 12 months. We compared the evolution of complications depending on the therapeutic strategy and according to the underlying etiology of hypercortisolism. After 6 months, patients in both surgery and medication group showed improvements in cortisol levels, weight, blood pressure, lipid profile, diabetes, and liver parameters. Weight loss was higher in the medication group (-1.61 VS + 0,25 kg/m² in surgery group) while there was no difference for the other parameters. This difference was persistentat 12 months. Patients with primary bilateral macronodular adrenocortical hyperplasia (PBMAH) who received medication showed a higher reduction in BMI (-1,98 VS + 0,68 kg/m²), systolic and diastolic blood pressure (-11,6 VS + 3 and − 4,5 VS + 5 mmHg respectively) than operated patients. No significant differences were observed for other etiologies. Our study suggests that medical treatment is more effective than surgery to improve weight in ACTH-independent hypercortisolism, especially in patients with PBMAH. Treatment modality does not appear to have any impact on other short-term metabolic complications.