AdrenalCosyntropin stimulation testing on postoperative day 1 allows for selective glucocorticoid replacement therapy after adrenalectomy for hypercortisolism: Results of a novel, multidisciplinary institutional protocol
Section snippets
Methods
This single institution, institutional review board–approved retrospective review used a prospectively collected database of 34 consecutive patients who underwent unilateral adrenalectomy for hypercortisolism or primary aldosteronism between November 2011 and September 2014. Excluded from the cohort were 3 patients with hypercortisolism who did not have a POD1 cosyntropin stimulation test (CST). Data collected included patient demographics, history of hypertension or diabetes mellitus,
Results
Of the 31 study patients, 22 (71%) had adrenal-dependent hypercortisolism; 9 patients (29%) with primary aldosteronism who had no evidence of cortisol excess served as the control group. The median age of the 31 patients was 58 years (range, 24–72); 23 (74%) were female, and the median body mass index (BMI) was 29.7 kg/m2 (range, 17.2–42.7). For all 31 patients, comorbidities included hypertension in 19 (61%) and diabetes mellitus in 7 (24%). Laparoscopic adrenalectomy was performed in 30
Discussion
Dysregulation of the HPA axis in patients with adrenal-dependent hypercortisolism can result in postoperative secondary AI after even a unilateral adrenalectomy.1, 2, 3, 5 This potential risk has clinically important consequences and has, therefore, resulted in the routine use of postoperative GR despite the many side effects of GR. In this study, we introduced an institutional algorithm to determine the need for GR after adrenalectomy in patients with adrenal-dependent hypercortisolism. Using
References (21)
- et al.
Cushing's syndrome
Lancet
(2006) Evaluation and treatment of Cushing's syndrome
Am J Med
(2005)- et al.
Cardiovascular events and mortality in patients with adrenal incidentalomas that are either non-secreting or associated with intermediate phenotype or subclinical Cushing's syndrome: a 15-year retrospective study
Lancet Diabetes Endocrinol
(2014) - et al.
Late-night salivary cortisol for the diagnosis of Cushing syndrome: a meta-analysis
Endocr Pract
(2009) - et al.
American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons Medical Guidelines for the management of Adrenal Incidentalomas
Endocr Pract
(2009) - et al.
The diagnosis and differential diagnosis of Cushing's syndrome and pseudo-Cushing's states
Endocr Rev
(1998) Glucocorticoid-induced adrenal insufficiency
JAMA
(1999)- et al.
Time to recovery of the hypothalamic-pituitary-adrenal axis after curative resection of adrenal tumors in patients with Cushing's syndrome
Surgery
(1990) - et al.
Unrecognized adrenal insufficiency in patients undergoing laparoscopic adrenalectomy
Surg Endosc
(2009) - et al.
Selective use of steroid replacement after adrenalectomy
Arch Surg
(2006)