More liberal use of bilateral adrenalectomy for bilateral adrenal tumours with cortisol excess
Menée à l'aide de données internationales portant sur 629 patients présentant des tumeurs surrénaliennes bilatérales et un excès de cortisol (âge médian : 62 ans ; 68 % de femmes), cette étude analyse l'incidence d'événements cardiovasculaires et la mortalité en fonction du traitement reçu (chirurgie ou non)
Bilateral adrenal tumours with cortisol hypersecretion represent a common clinical challenge. Adrenal incidentalomas are detected in approximately 4% of abdominal imaging studies, with prevalence increasing with patient age. Approximately 20% of adrenal incidentalomas are bilateral.1 Hormone excess is common in bilateral adrenal lesions, most often due to mild autonomous cortisol secretion (MACS), which accounts for approximately one-fifth of cases. In contrast to unilateral adrenal tumours, for which adrenalectomy is the standard treatment for overt Cushing's syndrome, the management of bilateral adrenal tumours with hypercortisolism (whether Cushing's syndrome or MACS) is more nuanced, requiring a dynamic, personalised approach. Current guidelines discourage bilateral adrenalectomy because of the risks associated with adrenal insufficiency.2–4 Following bilateral adrenalectomy, the annual mortality risk from adrenal crisis is approximately 0·5% of patients, as roughly 8% have an adrenal crisis each year, with a mortality rate of 17% per crisis.5 By comparison, the mortality risk from hypercortisolism (excluding ACTH-dependent cases) is substantially higher, affecting approximately 5% of patients per year.6 The existing literature regarding the approach and management of patients with bilateral adrenal lesions with hypercortisolism is limited by small sample sizes, heterogeneous classifications, and confounding biases, so the treatment decisions for these patients remain complex.
The Lancet Diabetes & Endocrinology , commentaire, 2026