Prolonged adrenal insufficiency after unilateral adrenalectomy for Cushing′s Syndrome

Abstract

The contralateral healthy adrenal in patients undergoing unilateral adrenalectomy for Cushing's is known to be suppressed temporarily and forms the basis of peri and postoperative steroids. We present four cases of Cushing's who had prolonged adrenal insufficiency with continued requirement for steroids for periods ranging 1–4 years after unilateral adrenalectomy for Cushing’s. We further review literature regarding the recovery of the hypothalamo pituitary adrenal axis postsurgery in patients with Cushing's syndrome.

The Incidence of Long-Term Adrenal Insufficiency Following Unilateral Adrenalectomy is Low: Case Series and Review of Literature

“…At our institution and others, all patients with evidence of hypercortisolism are placed on glucocorticoid supplementation following surgery to prevent adrenal crisis. This supplementation is weaned post-operatively, although recovery of endogenous cortisol production is sometimes prolonged [6].…”

“…The rates of early and prolonged adrenal insufficiency following unilateral adrenalectomy are incompletely defined in the literature [6][7][8]. Indeed, knowledge of this is essential for appropriate patient counseling and expectations for therapy needed after surgery.…”

Adrenal crisis in metastatic adrenal cortical carcinoma in an infant with neurofibromatosis type 1

“…In addition, ultrasound scan of abdomen was done at 3 months of age which did not reveal any intra-abdominal or retroperitoneal masses. ACCs are generally fast growing malignancies, detected at late stages 9 . Treatment depends on the tumour spread, general wellbeing and fitness of the patients for combined surgery, chemotherapy and radiotherapy 9 .…”

“…ACCs are generally fast growing malignancies, detected at late stages 9 . Treatment depends on the tumour spread, general wellbeing and fitness of the patients for combined surgery, chemotherapy and radiotherapy 9 .…”

Cirurgia poupadora de adrenal: uma nova abordagem no tratamento da hiperplasia macronodular adrenal primária

“…Esta condição exige que se realize reposição de glicocorticoides no intra e pós-operatório, para evitar crises e até que o eixo hipotálamo-hipófise-adrenal se normalize, como já foi previamente descrito(69). Acredita-se que um dos fatores mais determinantes no tempo de duração da insuficiência adrenal é o grau do hipercortisolismo, por isto, pacientes com graus mais graves de síndrome de Cushing levariam mais tempo para recuperar a função do eixo hipotálamo-hipófise-adrenal.Entretanto, os dados em literatura sobre a insuficiência adrenal pós-operatória são mais comumente relacionados a adrenalectomia unilateral para tratamento de síndrome de Cushing ou hipercortisolismo subclínico por nódulos autônomos(70,71). Lamas et al relataram quatro pacientes submetidos a adrenalectomia unilateral por HMAP, sendo que dois deles apresentaram insuficiência adrenal por, respectivamente, 14 e 60 meses após a cirurgia (63).…”