Endocrine Abstracts

Introduction: Adrenal insufficiency, or relative insufficiency, might partly explain increased mortality rates in nephroblastoma and neuroblastoma survivors after unilateral adrenalectomy. Aim of this study was to assess adrenal function and its metabolic effects after unilateral adrenalectomy.

Patients and Methods: Cross-sectional study with a socio-demographically similar control group, conducted between October 2009-March 2011 at the Erasmus University Medical Centre, the Netherlands. Sixty-seven adult long-term survivors of nephroblastoma, 36 survivors of neuroblastoma and 49 control subjects were included in this study. Adrenal function was assessed by a 1 μg short Synacthen-test. Cortisol, adrenocorticotrophic hormone (ACTH), low (LDL-C) and high-density lipoprotein-cholesterol (HDL-C), triglycerides, apolipoprotein-B, glucose and insulin levels were assessed in blood samples taken at baseline. In addition, cortisol levels were assessed after 30 (t=30) and 60 minutes. Homeostatic Model Assessment (HOMA) was calculated.

Results: Adrenal insufficiency was not present in survivors. Interestingly, baseline serum cortisol levels were higher in survivors after unilateral adrenalectomy (mean 503 nmol/l) (N=46) than in survivors with both adrenals intact (mean 393 nmol/l, P=0.002) (N=52), and than in controls (mean 399 nmol/l, P=0.013) (N=49). After correcting for age, sex, and use of oral estrogens, unilateral adrenalectomy was independently associated with elevated baseline cortisol and ACTH levels. Baseline cortisol levels were positively associated with triglycerides (P<0.001), LDL-C (P=0.004), apolipoprotein-B (P<0.001) and HOMA (P=0.008).

Conclusions: No adrenal insufficiency was observed in survivors of nephroblastoma and neuroblastoma. Survivors treated with unilateral adrenalectomy had relatively high basal cortisol and ACTH levels, indicating a higher central setpoint of the hypothalamic-pituitary-adrenal axis. This higher setpoint was associated with lipid concentrations and insulin resistance.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This work was supported, however funding details unavailable.