SUN-472 - Cardiometabolic, Sleep and Quality of Life Outcomes after Unilateral Adrenalectomy for Autonomous Cortisol Secretion: A Prospective Cohort Study

Context: Evidence on cardiometabolic, sleep and quality of life (QoL) outcomes following unilateral adrenalectomy in patients with unilateral vs bilateral adrenal nodules and autonomous cortisol secretion (ACS) is scarce.

Objective: To determine the impact of unilateral adrenalectomy on cardiometabolic comorbidities, sleep, and QoL in patients with ACS, and to analyze factors associated with improvement.

Methods: We conducted a single center prospective cohort study, 2019-2025, of patients with ACS who underwent unilateral adrenalectomy. Treatment and severity of hypertension, diabetes mellitus, and obesity, as well as Pittsburgh Sleep Quality Index (PSQI), SF-36, Cushing QoL were assessed at baseline and 12 months post-unilateral adrenalectomy. Associations of demographics, disease laterality (unilateral vs. bilateral adrenal nodularity/hyperplasia on imaging, regardless of functional laterality) and clinical and biochemical hypercortisolism severity with post-operative improvement in cardiometabolic comorbidities, sleep and QoL were investigated.

Results: 161 patients [71% unilateral and 29% bilateral adrenal disease, median age 58 years (IQR: 47-65), 76% women] underwent unilateral adrenalectomy. No differences in age, sex, BMI or prevalence of hypertension, diabetes mellitus or obesity were present between those with unilateral and bilateral disease at baseline. Post-unilateral adrenalectomy, when compared to patients with bilateral disease, a similar proportion of patients with unilateral disease demonstrated improvement in hypertension (53% vs 62%, P=0.358), diabetes (48% vs 43%, P=0.757), and obesity (32% vs 25%, P=0.539). In a multivariable analysis of age, sex, glucocorticoid use, laterality, and biochemical severity score, higher baseline biochemical severity score was associated with improvement in hypertension [OR 1.21 (95% CI: 1.01, 1.48, P=0.048] and obesity [OR 1.83, (95% CI: 1.34, 2.66, P< 0.001], but not diabetes. While overall CushingQoL score improved in both patients with unilateral [45 (SD 23) to 62 (SD 21), P< 0.001] and bilateral disease [40 (SD 20) to 52 (SD 21), P=0.006], mental component summary of SF-36 improved in only those with unilateral [39 (SD 12) to 44 (SD 13), P=0.001], but not in bilateral disease. PSQI scores improved in those with unilateral [11 (SD 5) to 9 (SD 5), P=0.005] and bilateral adrenal disease [13 (SD 5) to 10 (SD 5), P=0.007]. In a multivariable analysis of age, sex, glucocorticoid use, clinical severity and laterality, none of the analyzed factors were associated with change in the PSQI score or mental/physical components of SF-36.

Conclusion: We found that among patients with ACS, unilateral adrenalectomy was associated with comparable improvements in cardiometabolic comorbidities, sleep, and quality of life in those with unilateral and bilateral adrenal disease.

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