Impact of adrenalectomy on metabolic alterations and quality of life in mild autonomous cortisol secretion: results from the randomized CHIRACIC trial
In brief
Adrenalectomy leads to modest weight loss but no metabolic benefit
In the CHIRACIC randomized trial of 48 patients with unilateral adrenal incidentalomas and mild autonomous cortisol secretion, 21% of those undergoing adrenalectomy lost more than 5% of body weight versus 4% with conservative care, while improvements in glucose control, lipids, and quality of life were similar between groups. The results suggest surgery may help hypertension but offers limited advantage for weight or metabolic comorbidities, highlighting the need for larger trials.
- Journal
- European journal of endocrinology (Q1)
- Published
- 11 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- A Tabarin, S Espiard, T Deutschbein, L Amar, D Vezzossi, G Di Dalmazi, et al.
- PMID
- 42578946
- DOI
- 10.1093/ejendo/lvag142
Why clinicians should know about it
- Picked for Breast and Endocrine Surgery (top studies of the week, 16 August 2026): Adrenalectomy impact on MACS, endocrine surgical outcomes
Abstract
OBJECTIVE: The CHIRACIC trail supported the beneficial effect of adrenalectomy on hypertension in patients with unilateral adrenal incidentalomas associated with mild autonomous cortisol secretion (MACS). Additional assessments evaluated the impact of adrenalectomy on body weight excess, metabolic abnormalities and quality of life. DESIGN: Multicenter superiority open-label randomized trial comparing adrenalectomy to conservative management. METHODS: Following a run-in phase to control hypertension, receive lifestyle advice and treatment for comorbidities, patients underwent a workup including measurement of BMI, visceral and total fat, fat mass, fasting blood glucose, HbA1c, oral glucose tolerance test, plasma lipids and quality of life (QoL). Following randomization, assessment of comorbidities and adaptation of their treatment were performed every 3 months for 13 months. Workup was repeated at the end of the study. RESULTS: Forty-eight patients were randomly assigned to adrenalectomy (n = 23) and conservative management (n = 25). 93%, 71% and 90% of patients were overweight/obese, prediabetics/diabetics and dyslipidemic, respectively. There was no statistically significant improvement in anthropometric and metabolic parameters after adrenalectomy as compared to conservative management: 21% and 4% of adrenalectomized and conservatively treated obese/overweight patients lost > 5% of body weight, respectively (difference 22%, 95%CI: -2% to 39%). Glycemic status improved in 44% and 33% of adrenalectomized and conservatively treated dysglycemic patients, respectively (difference 10%, 95%CI: -22% to 43%). Dyslipidemia improved in 20% of adrenalectomized and none of conservatively treated dyslipidemic patients. Changes in QoL were not different between groups. CONCLUSION: The beneficial effects of adrenalectomy on excess weight, metabolic disorders and QoL demonstrated in the CHIRACIC trial are more limited than those observed for hypertension. Additional randomized interventional studies involving a larger number of patients are needed to support the use of adrenalectomy in the treatment of these comorbidities.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.