Acute hypercortisolism: what can the surgeon offer?

Abstract

Rapid onset or acute hypercortisolism is a rare critical illness requiring emergency management. The majority of patients will have underlying malignancy with surgery an obvious choice in the minority with resectable disease. For those with unresectable disease, medical management alone has been the traditional approach. However, this often proves inadequate raising interest in the role of surgery as palliation in this setting. Patient selection, timing of surgery and optimal surgical technique are areas of current controversy with little literature available to provide answers. Decisions regarding management of patients with acute hypercortisolism are complex, and these patients are best managed in a subspecialized setting.

Clinical Guidelines for the Management of Adrenal Incidentaloma

“…The prophylactic administration of a wide range of antibiotics before anesthesia can reduce the risk of infection [75]. Any patient who has undergone unilateral or bilateral adrenalectomy for a cortisol-producing adrenal adenoma will need steroid replacement therapy to prevent hypoadrenalism after surgery [7677]. Because ACTH secretion is suppressed by hypercortisolism, cortisol stimulation is insufficient after surgery.…”