EYES2023 ESE Young Endocrinologists and Scientists (EYES) 2023 Oral communication 1: Adrenal Diseases (8 abstracts)
Preoperative 1 mg dexamethasone suppression test predicts hypothalamus–pituitary–adrenal axis recovery: A one-year retrospective study of adrenal incidentalomas undergoing unilateral adrenalectomy
Ilaria Bonaventura 1 , Alessandra Tomaselli 2 , Francesco Angelini 2 , Davide Ferrari 2 , Dario De Alcubierre 3 , Valentina Sada 2 , Marianna Minnetti 2 , Valeria Hasenmajer 2 , Alessia Cozzolino 2 , Emilia Sbardella 2 , Andrea Isidori 2 & Riccardo Pofi 4
1Sapienza University of Rome, Experimental Medicine, Rome, Italy; 2Sapienza University of Rome, Italy; 3Claude Bernard Lyon 1 University, France; 4Ocdem, Nihr Oxford Biomedical Research Centre, University of Oxford, UK.
Background: The evaluation of postoperative adrenal insufficiency (PAI) and hypothalamus–pituitary–adrenal (HPA) axis recovery in patients with adrenal incidentaloma (AI) undergoing unilateral adrenalectomy remains limited.
Objectives: We aimed to identify predictive factors for PAI development and evaluate HPA axis recovery in AI patients undergoing unilateral adrenalectomy.
Methods: We retrospectively analysed adrenal function in 32 consecutive AI patients with histologically confirmed adrenal cortex adenomas who underwent unilateral adrenalectomy between 2019 and 2023. Before surgery, adrenal function was evaluated through ACTH, urinary free cortisol and serum cortisol after 1 mg dexamethasone suppression test (1 mg-DST). ACTH and serum cortisol or Short Synacthen Test were performed at 6 days, 6 weeks, 6 months, and one year postoperatively.
Results: Six days post-adrenalectomy, 18.8% of patients had normal adrenal function. Of those having PAI, 43.8% recovered at 6 weeks. Those patients recovering had lower preoperative 1 mg-DST compared to those still experiencing PAI at 6 weeks (median 1 mg-DST 69.5 nmol/l [95%CI 45.0–98.7] vs 260.0 nmol/l [95%CI 113.0–288.5], P < 0.01). A 1 mg-DST level ≤ 131 nmol/l predicted recovery with 89.5% sensitivity and 72.7% specificity and those patients below this threshold had a median HPA axis recovery time of 6 weeks, compared to 48 weeks for those above. ACTH levels rose postoperatively in all patients (P < 0.001) but did not predict HPA axis recovery.
Conclusions: The 1 mg-DST was found to be the best predictor of HPA axis recovery, indicating the importance of hypercortisolism severity in influencing PAI duration. Notably, pre and postoperative ACTH levels were not predictive of HPA axis recovery, suggesting they may not be regarded as beneficial in this context.
Article tools
My recent searches
My recently viewed abstracts
Authors
Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
© Bioscientifica 2024 |
Privacy policy |
Cookie settings
BiosciAbstracts
Bioscientifica Abstracts is the gateway to a series of products that provide a permanent, citable record of abstracts for biomedical and life science conferences.
Find out more