Endocrine Abstracts

Introduction: Primary aldosteronism (PA) is the most common cause of secondary hypertension that can be cured by surgery. Mild autonomous cortisol co-secretion is a recognised feature of PA, which is associated with an increased cardiometabolic penalty and the possibility of adrenal insufficiency postoperatively. There have also been case reports of adrenal crisis post adrenalectomy for this patient subtype. We report our experience of adrenal insufficiency post adrenalectomy for primary aldosteronism.

Method: We audited all patients who underwent unilateral adrenalectomy with confirmed diagnosis of PA, performed in our tertiary centre from 2013-2021. We reviewed electronic charts with clinical data, documented biochemistry, results of overnight dexamethasone and post operative morning cortisol or short synacthen test (SST) if done.

Results: There were 28 unilateral adrenalectomy for PA performed in our centre during the eight-year period. Preoperative overnight dexamethasone suppression tests were available in 17 patients, of whom 12 demonstrated normal cortisol suppression (< 50 nmol/l), whilst five (17%) failed to suppress. No patient received pre or intra- operative hydrocortisone. Post-operative cortisol levels were available in 27 patients. Six patients were discharged with hydrocortisone replacement, and this was weaned between two weeks to a maximum of eight months after HPA reassessment of HPA axis with either 9 am cortisol or SST. No patients experienced episodes of adrenal crisis.

Conclusions: Cortisol co-secretion was seen in 17% of our PA patients with adrenalectomy. Our audit demonstrated the post adrenalectomy patients with cortisol co-secretion requiring initial hydrocortisone replacement, but no patient experienced life-threatening adrenal crisis. The hydrocortisone treated patients had transient adrenal insufficiency with treatment successfully weaned off with complete recovery of HPA axis.