Postoperative adrenal insufficiency in Conn’s syndrome—does it occur frequently?
- 6 October 2021
- journal article
- review article
- Published by Springer Science and Business Media LLC in Journal of Human Hypertension
- Vol. 36 (6), 510-516
- https://doi.org/10.1038/s41371-021-00618-0
Abstract
Primary aldosteronism (PA) is the most frequent form of endocrine hypertension. Recently, frequent clinically significant adrenal insufficiency after adrenalectomy in subjects with PA has been reported, which may make the early postsurgical management difficult. We retrospectively searched for possible adrenal insufficiency in subjects who underwent adrenalectomy for PA and have measured cortisol in the early postoperative course. We included subjects with confirmed diagnosis of PA who underwent either posture testing (blood draw at 06:00 and 08:00) and/or adrenal venous sampling (AVS) (blood draw between 08:00 and 09:00) and have also measured cortisol after surgery (cortisol measured approximately at 07:00). Cortisol was measured by immunoassay. In this study, we identified 150 subjects (age 48.5 ± 10.3 years) with available cortisol values in the early postoperative course (median [25th percentile, 75th percentile]) 6 [5,6] days. Postoperative cortisol values (551 ± 148 nmol/l) were normal and significantly higher, compared to preoperative standing cortisol values (404 ± 150 nmol/l; (P < 0.001) and AVS cortisol values (493 ± 198 nmol/l; P = 0.009), and did not significantly differ from preoperative supine cortisol values. Postsurgical cortisol values were not different among subjects with or without abnormal dexamethasone suppression test or elevated urinary free cortisol pre-surgery, and were significantly higher in subjects with abnormal diurnal cortisol variability compared with subjects with normal diurnal variability. No patient presented with adrenocortical crisis in the later follow-up. In conclusion, postoperative cortisol values did not indicate any suspicion of possible adrenal insufficiency. To exclude possible adrenal insufficiency, it may be sufficient to measure morning cortisol in the early postoperative course.Funding Information
- Agentura Pro Zdravotnický Výzkum České Republiky (NV19-01-00083)
- Univerzita Karlova v Praze (Progres Q25, Progres Q28)
This publication has 34 references indexed in Scilit:
- Long-term effect of specific treatment of primary aldosteronism on carotid intima–media thicknessJournal of Hypertension, 2015
- Adrenal Function After Adrenalectomy for Subclinical Hypercortisolism and Cushing's Syndrome: A Systematic Review of the LiteratureJournal of Clinical Endocrinology & Metabolism, 2014
- Adrenal reserve function after unilateral adrenalectomy in patients with primary aldosteronismJournal of Hypertension, 2013
- Concurrent primary aldosteronism and subclinical cortisol hypersecretionJournal of Hypertension, 2011
- The Diagnosis of Cushing's Syndrome: An Endocrine Society Clinical Practice GuidelineJournal of Clinical Endocrinology & Metabolism, 2008
- Increased intima–media thickness of the common carotid artery in primary aldosteronism in comparison with essential hypertensionJournal of Hypertension, 2007
- Coexistence of different phenotypes in a family with glucocorticoid-remediable aldosteronismJournal of Human Hypertension, 2003
- Diagnosis of Adrenal Insufficiency: Evaluation of the Corticotropin-Releasing Hormone Test and Basal Serum Cortisol in Comparison to the Insulin Tolerance Test in Patients with Hypothalamic-Pituitary-Adrenal DiseaseJournal of Clinical Endocrinology & Metabolism, 2003
- Prevalence of primary hyperaldosteronism in moderate to severe hypertension in the Central Europe regionJournal of Human Hypertension, 2003
- Predictive Value of Preoperative Tests in Discriminating Bilateral Adrenal Hyperplasia from an Aldosterone-Producing Adrenal AdenomaJournal of Clinical Endocrinology & Metabolism, 2000