Adrenal insufficiency post unilateral adrenalectomy in non-cortisol secreting tumours.
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ABSTRACT:
SUBMITTER: Pinto D
PROVIDER: S-EPMC10660178 | biostudies-literature | 2023 Oct
REPOSITORIES: biostudies-literature
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Adrenal insufficiency post unilateral adrenalectomy in non-cortisol secreting tumours.
Pinto Diluka D Parameswaran Rajeev R
Gland surgery 20231026 10
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Project description:BackgroundCushing syndrome increases morbidity and mortality, which is mainly caused by cardiovascular disorders. This study reports the cardiovascular risk outcomes at 3, 6, and 12 months after unilateral laparoscopic adrenalectomy in cortisol-secreting adrenal tumor and to identify the preoperative parameters predicting the resolution of cardiovascular risk factors after surgery.MethodsAll clinical data of patients with unilateral cortisol-secreting adrenal tumors who underwent laparoscopic adrenalectomy in King Chulalongkorn Memorial Hospital between 2001-2022 were retrospectively reviewed. Analyzed baseline parameters included age, gender, body mass index (BMI), tumor size, and laterality. Systolic and diastolic blood pressure (DBP), fasting blood sugar (FBS), hemoglobin A1C (HbA1C), lipid profiles, and serum cortisol level were evaluated before surgery and at 3, 6, 12 months postoperatively. The resolution rate and predictive factors of hypertension (HT), diabetes, and dyslipidemia after surgery were analyzed.ResultsForty-five patients were included in this study. The mean [standard deviation (SD)] age was 44.2 (14.7) years. The mean (SD) BMI was 25.9 (5.4) kg/m2. The mean (SD) tumor size was 3.1 (1.0) cm. Most of the patients were female (97.8%). After surgery, the resolution rate of HT, dyslipidemia, and obesity were significantly improved after 3 months (P<0.001, P=0.01, and 0.02 respectively). Diabetes mellitus (DM) significantly improved at 1 year after surgery (P<0.001). From multivariable analysis, the significant predictive factors for the resolution of HT were age [odds ratio (OR) 0.95; 95% confidence interval (CI): 0.91-0.99, P=0.01], BMI (OR 0.85; 95% CI: 0.77-0.95, P=0.003) and systolic blood pressure (SBP) (OR 0.97; 95% CI: 0.94-1, P=0.03). Preoperative serum cortisol was the significant predictive factor for the improvement of diabetes (OR 1.12; 95% CI: 1.01-1.25, P=0.04) and serum cholesterol was the predictive factor for the improvement of dyslipidemia (OR 0.97; 95% CI: 0.96-0.99, P=0.003) after surgery.ConclusionsAdrenalectomy significantly improves the cardiovascular risk factors in cortisol-secreting adrenal adenoma.
| S-EPMC11635579 | biostudies-literature
Project description:BackgroundAdrenal Cushing's syndrome is caused by an adrenal tumor that produces hypercortisolism and requires glucocorticoid supplementation following resection of the tumour to prevent adrenal insufficiency. Few studies have examined whether glucocorticoid replacement (GR) therapy is required after retroperitoneal laparoscopic unilateral adrenal adenoma resection in patients with non-cortisol secreting tumors, or whether there is any correlation between preoperative biochemical indicators and postoperative cortisol function. This study sought to investigate which patients with non-cortisol secreting tumors required GR therapy after undergoing retroperitoneal laparoscopic resection of unilateral adrenal cortical adenoma.MethodsThis retrospective case-control study included patients who underwent unilateral adrenalectomy, and who had a postoperative pathological diagnosis of adrenal cortical adenoma. Including primary aldosteronism and non-functional adrenal adenoma. In total, 35 patients were included in the study, of whom 12 were male and 23 were female. All the patients successfully underwent retroperitoneal laparoscopy. The adrenal adenoma resection patients were divided into the following two groups based on whether they received GR therapy after surgery: (I) the no GR group, which comprised 28 patients; and (II) the GR group, which comprised 7 patients. Routine preoperative, adrenal-related, basal serum cortisol, and plasma adrenocorticotropic hormone (ACTH) tests were conducted, and the percentage of eosinophils, and the number of eosinophils were assessed each morning for 3 days after surgery. Repeated measures analysis of variance was used, and the F value was the main statistic used to test for differences between groups, which was used to evaluate the magnitude of differences between groups.ResultsBefore surgery, except for the ACTH level which showed a statistically significant difference between the two groups (P=0.04), there were no statistically significant differences between the two groups (P>0.05) in terms of eosinophil percentage, eosinophil count, serum potassium level, serum sodium level, cortisol levels (8 am, 4 pm, 12 am), and renin-angiotensin II-aldosterone levels (recumbent/standing), among others. After surgery, there were significant differences between the two groups in terms of the morning basal serum cortisol level (at 8 am) and the ACTH level (F=25.037, P<0.001; F=12.033, P=0.001), but no significant differences in the percentage and number of eosinophils were observed between the two groups. After laparoscopic adrenal adenoma resection, patients' cortisol levels are low on the first postoperative day, but most adrenal cortisol levels respond well to ACTH stimulation. On the second and third days after surgery, patients' cortisol levels generally return to normal without GR therapy. However, for patients with continuously low levels of cortisol and ACTH 3 days after surgery, supplemental glucocorticoids should be actively given in the early postoperative stage.ConclusionsThis study preliminarily showed that postoperative cortisol and ACTH levels can be used to identify patients at an increased risk of hypocortisolism after unilateral adrenal adenoma surgery, and to guide the use of GR therapy.
| S-EPMC11635575 | biostudies-literature
Project description: Not available
| S-EPMC6517116 | biostudies-literature
Project description:BackgroundPrimary bilateral macronodular adrenocortical hyperplasia (PBMAH) is a rare condition with untypical subclinical symptoms of Cushing's syndrome (CS). This study aimed to compare the clinical and pathological features of PBMAH with unilateral cortisol-secreting adrenal adenoma (UAA).MethodsWe prospectively included 46 PBMAH patients and 205 UAA patients from January 2000 to February 2014. Cortisol levels and 24 hours urine free cortisol (UFC) were determined at baseline and during dexamethasone suppression test (DST) using the chemiluminescence method. Computed tomography (CT) examination of the adrenal glands was performed in all patients. For patients treated with adrenalectomy, hematoxylin, and eosin, staining was performed for pathological examination.ResultsThe proportion of patients with autonomous cortisol secretion was significantly higher in PBMAH patients (39.1%) than UAA patients (6.8%). The PBMAH patients showed significantly lower levels of basal cortisol, low dose dexamethasone suppressed cortisol, and high dose dexamethasone suppressed cortisol than the UAA patients (452.6±183.3 vs. 578.7±166.4 nmol/L, P=0.003; 394.5±298.9 vs. 549.2±217.7 nmol/L, P=0.002; 397.3±282.3 vs. 544.3±187.6 nmol/L, P=0.003). Similarly, the PBMAH patients had significantly lower levels of basal 24 hours UFC, low dose dexamethasone suppressed 24 hours UFC, and high dose dexamethasone suppressed 24 hours UFC than the UAA patients (1,144.4±1,048.1 vs. 1,674.9±1,520.4 nmol/24 h, P=0.032; 1,157.3±1,483.5 vs. 1,940.1±1,360.9 nmol/24 h, P=0.003; 1,256.4±1,767.0 vs. 1,969.9±1,361.7 nmol/24 h, P=0.011).ConclusionsPBMAH is often associated with atypical CS symptoms. The clinical and imaging features of PBMAH are useful for the differential diagnosis of this disease.
| S-EPMC7576081 | biostudies-literature
Project description:Compensatory adrenal growth evoked by unilateral adrenalectomy (hemiadrenalectomy) constitutes one of the most frequently studied in vivo models of adrenocortical enlargement. This type of growth has been quite well characterized for its morphological, biochemical, and morphometric parameters. However, the molecular basis of compensatory adrenal growth is poorly understood. Therefore, the aim of this study was to investigate the rat adrenal transcriptome profile during the time of two previously described adrenocortical proliferation waves at 24 and 72 h after unilateral adrenalectomy. Surgical removal of the left adrenal or a sham operation was accomplished via the classic dorsal approach. As expected, the weight of the remaining right adrenal glands collected at 24 and 72 h after hemiadrenalectomy increased significantly. The transcriptome profile was identified by means of Affymetrix® Rat Gene 2.1 ST Array. The general profiles of differentially expressed genes were visualized as volcano plots and heatmaps. Detailed analyzes consisted of identifying significantly enriched gene ontological groups relevant to adrenal physiology, by means of DAVID and GOplot bioinformatics tools. The results of our studies showed that compensatory adrenal growth induced by unilateral adrenalectomy exerts a limited influence on the global transcriptome profile of the rat adrenal gland; nevertheless, it leads to significant changes in the expression of key genes regulating the circadian rhythm. Our results confirm also that regulation of compensatory adrenal growth is under complex and multifactorial control with a pivotal role of neural regulatory mechanisms and a supportive role of other components.
| S-EPMC5979382 | biostudies-literature
Project description:Hypercortisolism is caused by a cortisol-secreting adrenocortical tumour (ACT) in approximately 15%-20% of cases in dogs. Little is known about which molecular markers are associated with malignant behaviour of canine ACTs. The objective of this study was to identify molecular markers of prognosis, which could be useful to refine prognostic prediction and to identify potential treatment targets. Cortisol-secreting ACTs were included from 40 dogs, of which follow-up information was available. The ACTs were classified as low risk of recurrence tumours (LRT; n = 14) or moderate-high risk of recurrence tumours (MHRT; n = 26), based on the novel histopathological Utrecht score. Normal adrenals (NAs) were included from 11 healthy dogs as reference material. The mRNA expression of 14 candidate genes was analysed in the 40 ACTs and in 11 NAs with quantitative RT-PCR. The genes' expression levels were statistically compared between NAs, LRTs and MHRTs. Univariate and multivariate analyses were performed to determine the association of the genes' expression levels with survival. Seven genes were differentially expressed between NAs and ACTs, of which pituitary tumour-transforming gene-1 (PTTG1) and topoisomerase II alpha (TOP2A) were also differentially expressed between LRTs and MHRTs. In survival analyses, high expression levels of Steroidogenic factor-1 (SF-1), PTTG1 and TOP2A were significantly associated with poor survival. In conclusion, we have identified several genes that are part of the molecular signature of malignancy in canine ACTs. These findings can be used to refine prognostic prediction, but also offer insights for future studies on druggable targets.
| S-EPMC6899893 | biostudies-literature
Project description:Introduction and importanceAdrenal insufficiency (AI) is common after adrenalectomy for Primary Adrenal Cushing's syndrome (PACS), due to the inhibition of the Hypothalamic-Pituitary-Adrenal Axis (HPAA) by the functioning adrenal mass. The treatment of post-surgical AI is based mainly on glucocorticoid supplementation therapy. To date, however, there is no known predicting factor of the duration of supplementation therapy in patients treated with laparoscopic adrenalectomy for PACS.Case presentationWe report the case of a 22-year-old Caucasian female who presented with dyspnea, osteoporosis, vertebral collapses and fractures of the pelvis. The diagnosis of ACTH-independent Cushing's syndrome was provided. Abdominal MRI revealed a left adrenal mass suggestive for adrenal adenoma, highly suggestive for PACS. The patient underwent left laparoscopic adrenalectomy. After surgery, glucorticoid supplementation therapy was started. More than A-year steroid replacement therapy was necessary before the patient completely recovered the function of the HPAA. During this period the patient was strictly followed up in order to adjust pharmacologic treatment, thus allowing to investigate the possible causes of such a slow and hard recover of the contralateral adrenal gland function.ConclusionAI is common after adrenalectomy for PACS due to HPAA suppression. The duration of steroid replacement therapy may be vary depending on patient's characteristics and may be uncommonly long, as in our case. We concluded the not only cortisol and ACTH level, but also radiological findings, such as the size of the mass, its functional activity as well as the hypotrophy or atrophy of the contralateral adrenal gland may be predictive of the duration of the steroid therapy. These factors, if correctly studied before surgery, may be of help in tailoring the postoperative management of the patients after adrenalectomy.
| S-EPMC9142400 | biostudies-literature
Project description:ObjectiveTo identify predictors of hypothalamic-pituitary-adrenal (HPA) axis recovery interval and severity of glucocorticoid withdrawal symptoms (GWS) in patients undergoing adrenalectomy for corticotropin-independent cortisol excess.DesignThis is a retrospective study of patients with mild autonomous cortisol excess (MACE), moderate and severe Cushing syndrome (CS) who developed adrenal insufficiency after unilateral adrenalectomy between 1998 and 2017.ResultsAdrenalectomy was performed in 81 patients (79% women, median age 52 years [IQR 42-62]). HPA axis recovery occurred at a median of 4.3 months (IQR 1.6-11.4) after adrenalectomy (severe CS vs moderate CS vs MACE: median 11.4 vs 2.8 vs 2.1 months, P < 0.01). Main predictors of HPA axis recovery interval included: preoperative serum cortisol concentration after 1-mg overnight dexamethasone suppression test >10 μg/dL or >276 nmol/L (9.7 vs 1.3 months if cortisol ≤10 μg/dL or ≤276 nmol/L, P < 0.01); body mass index (for every 3 kg/m2 decrease, glucocorticoid taper increased by 1 month, P < 0.05); age <45 (11.4 vs 2.3 months if ≥45 years, P < 0.05); duration of symptoms prior to diagnosis >1 year (11.4 vs 2.8 months if ≤1 year); moon facies (11.4 vs 2.2 months if no rounding of the face); and myopathy (13.1 vs 2.7 months if no myopathy, P < 0.05). Patients with severe CS had a higher incidence of GWS compared to patients with MACE (66.7% vs 40.0%, P < 0.05) with a median of 1 and 0 events/patient, respectively.ConclusionsThe HPA axis recovery interval was the longest for patients with severe CS. Surprisingly, patients with moderate CS recovered their HPA axis as quickly as those with MACE. Glucocorticoid withdrawal symptoms were observed in all groups, with more events in patients with severe CS. This study emphasizes the need to counsel patients on expectations for HPA axis recovery and address intervention for GWS based on individual preoperative parameters.
| S-EPMC6246804 | biostudies-literature
Project description:ObjectiveAn ACTH stimulation test is the standard diagnostic test for adrenal insufficiency (AI). We aimed to investigate the diagnostic performance between serum morning (0800 h) cortisol and serum basal (0900-1300 h) cortisol levels and determine the proper cut-off point to facilitate AI diagnosis to reduce the number of tests.MethodsA six-year retrospective study was performed in a tertiary care medical center. We identified 416 patients who had undergone either low (LDT) or high dose (HDT) ACTH stimulation outpatient tests. AI was defined as a peak serum cortisol level of <500 nmol/L at 30 or 60 minutes after LDT or HDT. The associations between AI and serum basal and morning cortisol levels were demonstrated by logistic regression model. Diagnostic performance was evaluated by ROC analysis.ResultsOf the 416 patients, 93 (22.4%) were categorized as having AI. The adjusted area under the curve (AUC) for the basal cortisol level for the diagnosis of AI was significantly higher than that for the morning cortisol (0.82 vs 0.69, p <0.001) level. The proposed cut-off values for the basal cortisol were <85 nmol/L (specificity 99.7%) and >350 nmol/L(sensitivity 98.9%). By using these proposed cut-off points, approximately 30% of the ACTH stimulation tests could be eliminated.ConclusionThe serum basal cortisol level with the proposed cut-off points were considered as an alternative option for diagnosis of AI. Utilizing the serum basal cortisol level can facilitate AI diagnosis as it is convenient, is not a time-specific test and has a high diagnostic performance.
| S-EPMC6860436 | biostudies-literature
Project description:PurposePrimary bilateral adrenal hyperplasia (PBMAH) is associated with hypercortisolism and a heterogeneous clinical expression in terms of cortisol secretion and related comorbidities. Historically, treatment of choice was bilateral adrenalectomy (B-Adx); however, recent data suggest that unilateral adrenalectomy (U-Adx) may be an effective alternative. For the latter, factors predicting the postsurgical outcome (e.g., biochemical control) have not been identified yet.MethodsPBMAH patients undergoing U-Adx for overt Cushing's syndrome (CS) in two tertiary care centers were retrospectively analysed. Remission was defined as a normalization of urinary free cortisol (UFC) without the need for medical treatment. The potential of hCRH test as a predictor of U-Adx outcome was evaluated in a subgroup.Results23 patients were evaluated (69% females, mean age 55 years). Remission rate after U-Adx was 74% at last follow up (median 115 months from UAdx). Before U-Adx, a positive ACTH response to hCRH (Δ%ACTH increase > 50% from baseline) was associated with higher remission rates.ConclusionsThree of four patients with PBMAH are surgically cured with U-Adx. Pre-operative hCRH testing can be useful to predict long-term remission rates.
| S-EPMC10904413 | biostudies-literature