Faculty Collaboration Database

Selective Glucocorticoid Replacement Following Unilateral Adrenalectomy for Hypercortisolism and Primary Aldosteronism. J Clin Endocrinol Metab 2022 Jan 18;107(2):e538-e547

Date

09/25/2021

Pubmed ID

34558612

DOI

10.1210/clinem/dgab698

Scopus ID

2-s2.0-85123650141 (requires institutional sign-in at Scopus site)   12 Citations

Abstract

CONTEXT: An institutional study previously demonstrated that cosyntropin stimulation testing on postoperative day 1 (POD1-CST) identified patients at risk for adrenal insufficiency (AI) following unilateral adrenalectomy (UA) for adrenal-dependent hypercortisolism (HC) and primary aldosteronism (PA), allowing for selective glucocorticoid replacement (GR).

OBJECTIVE: This study re-evaluates the need for GR following UA for patients with HC and PA in a larger cohort.

METHODS: A prospective database identified 108 patients who underwent UA for mild autonomous cortisol excess (MACE) (n = 47), overt hypercortisolism (OH) (n = 27), PA (n = 22), and concurrent PA/HC (n = 12) from September 2014 to October 2020; all underwent preoperative evaluation for HC. MACE was defined by the 1 mg dexamethasone suppression test (cortisol >1.8 μg/dL), with ≥5 defined as OH. GR was initiated for basal cortisol ≤5 or stimulated cortisol ≤14 (≤18 prior to April 2017) on POD1-CST.

RESULTS: Fifty-one (47%) patients had an abnormal POD1-CST; 54 (50%) were discharged on GR (27 MACE, 20 OH, 1 PA, 6 PA/HC). Median duration of GR was OH: 6.0 months, MACE: 2.1 months, PA: 1 month, PA/HC: 0.8 months. Overall, 26% (n = 7) of patients with OH and 43% (n = 20) of patients with MACE did not require GR. Two (2%) patients with OH had normal POD1-CST but developed AI several weeks postoperatively requiring GR. None experienced life-threatening AI.

CONCLUSION: POD1-CST identifies patients with HC at risk for AI after UA, allowing for selective GR. One-quarter of patients with OH and nearly half of patients with MACE can forgo GR after UA. Patients with PA do not require evaluation for AI if concurrent HC has been excluded preoperatively.

Author List

DeLozier OM, Dream SY, Findling JW, Carroll TB, Evans DB, Wang TS

Authors

Sophie Y. Dream MD Assistant Professor in the Surgery department at Medical College of Wisconsin
Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin
James W. Findling MD Professor in the Medicine department at Medical College of Wisconsin
Tracy S. Wang MD, MPH Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adrenal Glands
Adrenal Insufficiency
Adrenalectomy
Aged
Cosyntropin
Cushing Syndrome
Female
Glucocorticoids
Hormone Replacement Therapy
Humans
Hyperaldosteronism
Male
Middle Aged
Postoperative Complications
Postoperative Period
Prospective Studies
Retrospective Studies
Risk Assessment