Faculty Collaboration Database

Cosyntropin stimulation testing on postoperative day 1 allows for selective glucocorticoid replacement therapy after adrenalectomy for hypercortisolism: Results of a novel, multidisciplinary institutional protocol. Surgery 2016 Jan;159(1):259-65

Date

10/01/2015

Pubmed ID

26422766

DOI

10.1016/j.surg.2015.05.034

Scopus ID

2-s2.0-84952637438 (requires institutional sign-in at Scopus site)   26 Citations

Abstract

BACKGROUND: Secondary adrenal insufficiency (AI) can occur after unilateral adrenalectomy for adrenal-dependent hypercortisolism. Postoperative glucocorticoid replacement (GR), although given routinely, may not be necessary. We sought to identify factors that, in combination with postoperative day 1 cosyntropin stimulation testing (POD1-CST), would predict the need for GR.

METHODS: We reviewed 31 consecutive patients who underwent unilateral adrenalectomy for hypercortisolism (study patients) or hyperaldosteronism (control patients). A standard POD1-CST protocol was used. Hydrocortisone was started for clinical evidence of AI, basal plasma cortisol ≤ 5 (μg/dL), or a stimulated plasma cortisol <18.

RESULTS: A normal POD1-CST was found in all nine control patients and 11 of 22 patients (50%) with Cushing's syndrome; the other 11 study patients (50%) received GR based on the POD1-CST. These patients were younger (51 vs 62 years; P = .017), had a higher body mass index (BMI; 31 vs 29 kg/m(2)), and smaller adrenal neoplasms (16.9 vs 33.0 g; P = .009) than non-GR study patients.

CONCLUSION: After unilateral adrenalectomy for hypercortisolism, only 50% of patients received GR. No preoperative biochemical characteristics were associated with postoperative AI, although patients who received GR were younger, and tended to have a higher BMI and smaller adrenal nodules. Use of this novel protocol for postoperative dynamic adrenal function testing prevented unnecessary GR in 50% of patients and allowed for individualized patient care.

Author List

Ortiz DI, Findling JW, Carroll TB, Javorsky BR, Carr AA, Evans DB, Yen TW, Wang TS

Authors

Ty Carroll MD Associate Professor in the Medicine 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
Bradley R. Javorsky MD Associate 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
Tina W F Yen MD, MS Professor in the Surgery department at Medical College of Wisconsin

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

Adrenal Cortex Function Tests
Adrenal Cortex Hormones
Adrenal Cortex Neoplasms
Adrenal Insufficiency
Adrenalectomy
Adult
Aged
Clinical Protocols
Cosyntropin
Cushing Syndrome
Female
Hormone Replacement Therapy
Humans
Male
Middle Aged
Retrospective Studies
Young Adult