Synacthen Stimulation Test Following Unilateral Adrenalectomy Needs to Be Interpreted With Caution.
Adenoma
/ metabolism
Adrenal Gland Neoplasms
/ physiopathology
Adrenal Insufficiency
/ metabolism
Adrenalectomy
/ methods
Adult
Aged
Cosyntropin
/ pharmacology
Cushing Syndrome
/ metabolism
Dexamethasone
/ pharmacology
Endocrinology
/ methods
Female
Humans
Hydrocortisone
/ metabolism
Hyperaldosteronism
/ metabolism
Male
Middle Aged
Pheochromocytoma
/ metabolism
Postoperative Period
Retrospective Studies
adrenal insufficiency
adrenalectomy
autonomous cortisol secretion
over-night dexamethasone suppression test
synacthen stimulation test
Journal
Frontiers in endocrinology
ISSN: 1664-2392
Titre abrégé: Front Endocrinol (Lausanne)
Pays: Switzerland
ID NLM: 101555782
Informations de publication
Date de publication:
2021
2021
Historique:
received:
16
01
2021
accepted:
28
04
2021
entrez:
28
5
2021
pubmed:
29
5
2021
medline:
22
12
2021
Statut:
epublish
Résumé
Cortisol levels in response to stress are highly variable. Baseline and stimulated cortisol levels are commonly used to determine adrenal function following unilateral adrenalectomy. We report the results of synacthen stimulation testing following unilateral adrenalectomy in a tertiary referral center. Data were collected retrospectively for 36 patients who underwent synacthen stimulation testing one day post unilateral adrenalectomy. None of the patients had clinical signs of hypercortisolism preoperatively. No patient received pre- or intraoperative steroids. Patients with overt Cushing's syndrome were excluded. The median age was 58 (31-79) years. Preoperatively, 16 (44%) patients had a diagnosis of pheochromocytoma, 12 (33%) patients had primary aldosteronism and 8 (22%) patients had non-functioning adenomas with indeterminate/atypical imaging characteristics necessitating surgery. Preoperative overnight dexamethasone suppression test results revealed that 6 of 29 patients failed to suppress cortisol to <50 nmol/L. Twenty (56%) patients achieved a stimulated cortisol ≥450 nmol/L at 30 minutes and 28 (78%) at 60 minutes. None of the patients developed clinical adrenal insufficiency necessitating steroid replacement. Synacthen stimulation testing following unilateral adrenalectomy using standard stimulated cortisol cut-off values would wrongly label many patients adrenally insufficient and may lead to inappropriate prescriptions of steroids to patients who do not need them.
Sections du résumé
Background
Cortisol levels in response to stress are highly variable. Baseline and stimulated cortisol levels are commonly used to determine adrenal function following unilateral adrenalectomy. We report the results of synacthen stimulation testing following unilateral adrenalectomy in a tertiary referral center.
Methods
Data were collected retrospectively for 36 patients who underwent synacthen stimulation testing one day post unilateral adrenalectomy. None of the patients had clinical signs of hypercortisolism preoperatively. No patient received pre- or intraoperative steroids. Patients with overt Cushing's syndrome were excluded.
Results
The median age was 58 (31-79) years. Preoperatively, 16 (44%) patients had a diagnosis of pheochromocytoma, 12 (33%) patients had primary aldosteronism and 8 (22%) patients had non-functioning adenomas with indeterminate/atypical imaging characteristics necessitating surgery. Preoperative overnight dexamethasone suppression test results revealed that 6 of 29 patients failed to suppress cortisol to <50 nmol/L. Twenty (56%) patients achieved a stimulated cortisol ≥450 nmol/L at 30 minutes and 28 (78%) at 60 minutes. None of the patients developed clinical adrenal insufficiency necessitating steroid replacement.
Conclusions
Synacthen stimulation testing following unilateral adrenalectomy using standard stimulated cortisol cut-off values would wrongly label many patients adrenally insufficient and may lead to inappropriate prescriptions of steroids to patients who do not need them.
Identifiants
pubmed: 34046013
doi: 10.3389/fendo.2021.654600
pmc: PMC8147556
doi:
Substances chimiques
Cosyntropin
16960-16-0
adrenocorticotropin zinc
53468-06-7
Dexamethasone
7S5I7G3JQL
Hydrocortisone
WI4X0X7BPJ
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
654600Informations de copyright
Copyright © 2021 Zaman, Almazrouei, Sam, DiMarco, Todd, Palazzo, Tan, Dhillo, Meeran and Wernig.
Déclaration de conflit d'intérêts
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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