Endocrine Abstracts

Background: Resection of the adrenal gland is a challenging intervention that requires close endocrinological supervision for the correct assessment of hormones to minimise complications peri-operatively (peri-op) and post-operatively (post-op).

Objectives: This study assessed the function of the hypothalamus–pituitary–adrenal axis and the related management according to underlying adrenal disorders.

Methods: We reviewed 163 patients who underwent unilateral adrenalectomy between April 2016 and October 2022. Patients were divided into cohort A (Cushing’s disease (CD), adrenocortical carcinoma and adrenal metastasis) and cohort B (Conn’s disease, incidentaloma, and phaeochromocytoma (PCC)). We audited the pre-operative (pre-op) and post-op assessments, including the peri-op steroid plan.

Results: Cohort A vs B was more frequently investigated with pre-op urine cortisol (20.8% vs 12.1%) and overnight dexamethasone suppression test (ODST) (25.0% vs 6.9%). Cohort A vs B had more frequently documented peri-op steroid plans (41.7% vs 29.3%) and more frequently required post-op steroid treatment (62.5% vs 17.2%). Post-op ODST and Short Synacthen Test (SST) was done more frequently for cohort A vs B (ODST 29.2% vs 13.8%, SST 4.2% vs 0.0%). Within cohort A, CD patients vs endocrine cancers had more frequenlty documented peri-op steroid plans (55.6% vs 33.3%) and more frequently required post-op steroid treatment (88.9% vs 46.7%). Post-op OSDT was only done in CD patients (ODST 77.8%, SST 11.1%). Within cohort B, peri-op steroid plans were implemented more frequently for Conn’s patients, followed by incidentaloma patients and PCC patients. Post-op ODST was performed only in incidentaloma (17.2%) and PCC cases (13.6%).

Conclusion: A uniform protocol is recommended for the hormonal assessment of patients who are planned for unilateral adrenalectomy in order to minimise the risk of post-op cortisol deficiency and/or life-threatening adrenal crisis.