Surgery Treats Hypertension in Patients With Adrenal Tumours
In patients with unilateral adrenal incidentalomas and mild autonomous cortisol secretion (MACS), adrenalectomy was well tolerated and enabled a reduction or cessation of hypertensive treatment while maintaining blood pressure within normal ranges.
METHODOLOGY:
Researchers conducted this clinical trial in university hospitals across Europe to assess the effect of adrenalectomy on hypertension in patients with unilateral benign adrenal incidentalomas and MACS.
They enrolled patients with a unilateral adrenal adenoma (≥ 2 cm) and MACS, in whom hypertension was confirmed through multiple home blood pressure measurements; a standardised stepped-care antihypertensive treatment was implemented until the measurements normalised to less than 135/85 mm Hg.
A total of 52 patients (median age, 63.3 years; 69% women) were then randomly assigned to either undergo adrenalectomy or receive conservative management and were followed up for 13 months; after randomisation, antihypertensive medications were adjusted on the basis of the stepped-care treatment approach.
The primary outcome was the proportion of patients in each group who reduced their antihypertensive treatment by at least one step while maintaining normal home blood pressure measurements (< 135/85 mm Hg).
TAKEAWAY:
A higher proportion of patients in the adrenalectomy group were able to reduce antihypertensive treatment by at least one step while maintaining normal home blood pressure measurements than those in the conservative management group (46% vs 15%; adjusted risk difference, 0.34; P = .0038).
= .0038). Among the patients who underwent adrenalectomy, more than half (52%) were able to discontinue all antihypertensive medications while maintaining normal systolic home blood pressure measurements (< 135 mm Hg); however, none of the patients achieved this after conservative management.
Serious adverse events were reported in 35% of patients who underwent adrenalectomy and 31% of those who received conservative management, with no deaths reported in either group.
IN PRACTICE:
"For individuals with hypertension and clear biochemical evidence of MACS, especially those with larger adrenal adenomas, this study helps support the case for adrenalectomy," experts wrote in a commentary.
SOURCE:
This study was led by Antoine Tabarin, MD, Department of Endocrinology, Diabetology, Metabolism and Nutrition, CHU Bordeaux, Bordeaux, France. It was published online on May 12, 2025, in The Lancet Diabetes & Endocrinology .
LIMITATIONS:
This study was limited by a small sample size. The criteria used for diagnosing adrenal insufficiency might have led to the overdiagnosis and potential overtreatment of patients. The findings cannot be extrapolated to patients with bilateral adrenal incidentalomas and MACS.
DISCLOSURES:
This study was supported by a grant from the French Ministry of Health, and the German part of the study was additionally supported by the German Research Foundation. Some authors reported receiving honoraria, research grants, and support for attending meetings and having several other ties with various pharmaceutical companies and other sources.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Medscape
2 hours ago
- Medscape
Study Supports Follow-Up Consultations After Heart Failure
About 40% of patients with diagnosed heart failure did not pursue future cardiology consultations, regardless of the initial severity of their condition. A single follow-up cardiology visit can reduce 1-year all-cause mortality by 6%-9%, with additional visits showing increased benefit as the severity of heart failure increases. METHODOLOGY: A nationwide cohort study included 655,919 French patients (median age, 80 years; 48% women) diagnosed or hospitalized with heart failure between January 1, 2015, and December 31, 2019, and who were still alive on January 1, 2020. Researchers categorized patients into four groups: Those hospitalized with heart failure within the past year, those hospitalized with the condition between 1 and 5 years prior, patients not hospitalized but who were receiving loop diuretics, and patients who were not hospitalized and were not taking loop diuretics. TAKEAWAY: The 1-year risk for all-cause mortality ranged from 8% in patients without hospitalization or use of loop diuretics to 25% for those hospitalized for heart failure within the past year. Mortality risk increased progressively across groups, with an adjusted hazard ratio of 1.61 for patients using loop diuretics, 1.83 for patients using loop diuretics and hospitalized over 1 year prior, and 2.32 for patients hospitalized less than 1 year prior ( P < .0001 for all). < .0001 for all). A single cardiology consultation was associated with a 6%-9% absolute reduction in 1-year all-cause mortality across all groups. The optimal follow-up strategy varied by risk group: One annual visit for low-risk patients, two to three visits for intermediate-risk patients, and four visits for high-risk patients recently hospitalized with heart failure. IN PRACTICE: 'Despite having an HF diagnosis, 40% of patients do not see a cardiologist annually, regardless of disease severity. Simple stratification based on hospitalization history and diuretic use effectively predicts outcomes. Tailoring the annual number of [heart failure] consultations according to this stratification could optimize resource use and reduce avoidable modelled deaths,' the researchers wrote. 'This group represents a significant opportunity to improve survival outcomes with only a modest increase in the total number of consultations. Healthcare systems could formally assess the impact of this annual consultation through large-scale cluster trials, allowing for an evaluation of the broader population-level benefits of this approach,' they added. SOURCE: The study was led by Guillaume Baudry, MD, of the Université de Lorraine in Nancy, France. It was published online in the European Heart Journal and presented at the Heart Failure Association of the European Society of Cardiology (HFA-ESC) 2025 meeting. LIMITATIONS: Researchers excluded patients residing in nursing homes due to their advanced prognosis and unavailability of healthcare utilization data, which may have led to an underestimation of morbidity and mortality. The study did not include heart failure patients who had not been recently hospitalized and did not submit long-term condition paperwork. Important clinical data such as ejection fraction, heart failure phenotype, and prognostic biomarker values were unavailable. DISCLOSURES: The researchers reported receiving fees and grants and other relationships with various pharmaceutical companies including Abbott, AstraZeneca, Bayer, and Pfizer.
Los Angeles Times
12 hours ago
- Los Angeles Times
U.N. Ocean Conference sets sail off France on World Oceans Day
NICE, France — Dozens of research and exploration vessels from around the world set sail just off the French coastal city of Nice on Sunday to kick off the third U.N. Ocean Conference and mark World Oceans Day. At the 'Ocean Wonders' event, vessels sailed across Nice's Baie des Anges, or Bay of Angels, to spotlight the beauty and importance of the ocean while urging world leaders to not lose sight of its value as they make decisions about the planet's future. Thousands of delegates, including heads of state, scientists and environmental advocates, are expected in Nice this week to confront growing threats to the ocean and the need to transform pledges into protection. The United Nations has called the threats a global emergency facing the world's oceans as they face rising temperatures, plastic pollution choking marine life, and relentless overexploitation of fish and other resources. Just 2.7% of the global ocean is effectively protected from destructive activities such as industrial fishing and deep-sea mining — far below the global goal of 30% by 2030. Participating boats included the Energy Observer, a solar-panel covered catamaran that was the first vessel to circumnavigate the globe using only renewable energy. It produces hydrogen fuel on board via seawater electrolysis, offering a vision of zero-emissions maritime travel. Other standout vessels included France's Alfred Merlin, dedicated to underwater archaeology; the OceanXplorer, a high-tech billionaire-owned research yacht; and the WWF's Blue Panda, which is working to map and protect the last remaining seagrass meadows in the Mediterranean Sea. At the heart of the conference is the push to ratify the High Seas Treaty, adopted in 2023. If it takes effect, the treaty would for the first time allow countries to establish marine protected areas in international waters, which cover nearly two-thirds of the ocean and remain largely ungoverned. 'The High Seas Treaty is critical to ensuring we can protect biodiversity in the ocean,' said Rebecca Hubbard, director of the High Seas Alliance. 'We're in the middle of a biodiversity and climate crisis. We absolutely have to protect the ocean to address those crises.' But even in waters already designated as protected, enforcement often falls short. Many countries, France included, face criticism from environmental groups over weak regulation and continued industrial activity within their marine protected areas. 'The ambition is not there, the speed is not there, and the scale has not been there,' said Sílvia Tavares, project manager at Oceano Azul Foundation. 'Moments like UNOC are key to changing that.' Several countries are expected to announce new marine protected areas, or MPAs, during the conference, along with bans on bottom trawling and other destructive activities within their existing MPA networks. The 'Ocean Wonders' fleet will remain docked in Nice and open to the public until the conference concludes Friday. Hammerschlag writes for the Associated Press.
Yahoo
12 hours ago
- Yahoo
Bed Bugs May Have Been The First Urban Pest to Ever Plague Humans
Humans were letting the bed bugs bite long before beds existed, and while they do live on other species, we're the main reason this notorious parasite is still going strong. In fact, bed bugs might have been the first pest to plague our cities – earlier than the black rat, for instance, which joined us in urban life about 15,000 years ago, and even the German cockroach, which only got the memo about 2,100 years ago. Researchers think the blood-sucking pests – Cimex lectularius – first jumped from their bat hosts onto a passing human some 50,000 years ago, a move which would change the course of the insect species forever. Human bed bugs, it turns out, have boomed since the Last Glacial Maximum about 20,000 years ago. But it's a different story for those populations that continued living on bats. "Initially with both populations, we saw a general decline that is consistent with the Last Glacial Maximum; the bat-associated lineage never bounced back, and it is still decreasing in size," says entomologist Lindsay Miles, from Virginia Tech. "The really exciting part is that the human-associated lineage did recover and their effective population increased." The researchers were able to track this evolution because the human bed bugs have a much narrower genetic diversity, since only a few 'founders' probably came with us when we abandoned life in caves. But our move into cities around 12,000 years ago is what really kicked off the human bed bug boom. This was only briefly interrupted when DDT was invented in the 1940s. Populations crashed, humans slept sweetly, and then five years later, the bed bugs were back. Since then, bed bugs have travelled around the world with us, and even become resistant to our pesticides. For now, it seems, bed bugs are here to stay. It's been a long-term relationship, after all. The research is published in Biology Letters. Your Brain Wrinkles Are Way More Important Than We Ever Realized Something Strange Happens to Your Eyes When You're Sexually Aroused 2-Year-Old Prodigy Joins 'High IQ' Club Mensa as Youngest Member Ever
