■进行了这项系统评价和荟萃分析,以比较肾上腺切除术和保守治疗对诊断为MACS的患者与轻度自主性皮质醇分泌(MACS)相关的合并症的益处。
■MACS是最常见的良性分泌激素的功能性肾上腺偶发瘤。在MACS患者中观察到皮质醇的过度产生,导致各种长期的健康问题,包括动脉高血压(HTN),糖尿病(DM),血脂异常,肥胖,和骨质疏松症;然而,Cushing综合征(CS)的经典临床表现不存在。
■使用MEDLINE进行了系统搜索,Embase,WebofSciences,和12月的Scopus数据库,2023年。两名审稿人独立地提取数据并评估所包含文章的质量。进行了荟萃分析,以比较肾上腺切除术与保守治疗MACS相关合并症的有益效果。
■本研究包括15篇文章,评估了933例MACS患者(384例肾上腺切除术和501例保守治疗,48例由于随访持续时间不完整而被排除)。纳入文献的MACS诊断标准不同。所有研究,然而,声明必须没有明显的CS症状。Meta分析显示肾上腺切除术相对于保守治疗MACS相关合并症的总体优势(Cohen\'sd=-0.49,95%CI[-0.64,-0.34],p=0.00)。亚组分析显示收缩压(合并效应大小=-0.81,95%CI[-1.19,-0.42],p=0.03),舒张压(合并效应大小=-0.63,95%CI[-1.05,-0.21],p=0.01),和骨密度(合并效应大小=-0.40,95%CI[-0.73,-0.07],p=0.02)显着有利于肾上腺切除术组而不是保守治疗,但在其他MACS相关合并症方面,两个治疗组之间没有显着差异。
■尽管数据有限且多样,这项研究证明了肾上腺切除术比保守治疗MACS相关合并症的优势.
UNASSIGNED: This systematic review and meta-analysis was conducted to compare the benefits of adrenalectomy and conservative treatment for comorbidities associated with mild autonomous cortisol secretion (MACS) in patients diagnosed with MACS.
UNASSIGNED: MACS is the most common benign hormone-secreting functional adrenal incidentaloma. Overproduction of cortisol is observed in MACS patients, resulting in a variety of long-term health issues, including arterial hypertension (HTN), diabetes mellitus (DM), dyslipidemia, obesity, and osteoporosis; however, the classic clinical manifestations of Cushing\'s syndrome (CS) are not present.
UNASSIGNED: A systematic search was conducted using MEDLINE, Embase, Web of Sciences, and Scopus databases on December, 2023. Two reviewers independently extracted data and assessed the quality of the included articles. A meta-analysis was performed to compare the beneficial effects of adrenalectomy versus conservative management for MACS-related comorbidities.
UNASSIGNED: Fifteen articles were included in this study, which evaluated 933 MACS patients (384 Adrenalectomy and 501 Conservative treatment, and 48 excluded due to incomplete follow-up duration). MACS diagnosis criteria were different among the included articles. All studies, however, stated that there must be no overt CS symptoms. Meta-analysis demonstrates the overall advantage of adrenalectomy over conservative treatment for MACS-related comorbidities (Cohen\'s d = -0.49, 95% CI [-0.64, -0.34], p = 0.00). Subgroup analysis indicated that the systolic blood pressure (pooled effect size = -0.81, 95% CI [-1.19, -0.42], p = 0.03), diastolic blood pressure (pooled effect size = -0.63, 95% CI [-1.05, -0.21], p = 0.01), and BMD (pooled effect size = -0.40, 95% CI [-0.73, -0.07], p = 0.02) were significantly in favor of adrenalectomy group rather than conservative treatment but no significant differences between the two treatment groups in other MACS-related comorbidities were reported.
UNASSIGNED: Despite the limited and diverse data, this study demonstrates the advantage of adrenalectomy over conservative treatment for MACS-related comorbidities.