Login to Access Video or Poster Abstract: MP37-10
Sources of Funding: none

Introduction

Acquired adrenal insufficiency is a risk of unilateral adrenalectomy, performed either to remove a functional tumor or a gland with suspicion of cancer. All patients with evidence of a cortisol-secreting tumor receive a steroid taper in the first weeks after surgery, but some patients require an extended course of cortisol supplementation. Our objective was to determine the incidence of adrenal insufficiency at 30 days and at 1 year, as identified by requiring exogenous hormones to treat symptoms or abnormal laboratory values.

Methods

A retrospective review was performed for all unilateral adrenalectomies at our institution from 2008-2016. Patient characteristics such as age and gender were recorded as risk factors, and surgical parameters such as laterality and pathology result, as well as tumor functionality were recorded. Logistic regression was used to determine which factors were associated with adrenal insufficiency as measured by cortisol supplementation at 30 days and at 1 year.

Results

There were 115 unilateral adrenalectomies performed; 102 were laparoscopic and 13 were open. 62% of these were left-sided. Mean patient age was 56 and 64% of patients were female. 57 patients (50%) had biochemical evidence of a functional tumor prior to surgery. 9 patients (7.8%) required cortisol supplementation 30 days after surgery, and only 1 of these patients still required steroids (0.9%) at 1 year. All of these patients had signs and symptoms of hypercortisolism prior to adrenalectomy. Patients with a functional tumor were significantly more like to develop adrenal insufficiency (16%) at 30 days than those with a nonfunctional tumor (0%, p<0.005). Of the 9 patients requiring supplementation, 7 had adrenal cortical adenomas and 2 had adrenal hyperplasia. Gender was the only significant patient risk factor that predicted adrenal insufficiency at 30 days; (12% of females, 0% of males, p<0.05).

Conclusions

The incidence of adrenal insufficiency following unilateral adrenalectomy is low. Most patients who require hormone supplementation 30 days following surgery are able to wean off this requirement by 1 year. These data may help provide reassurance to patients undergoing adrenalectomy concerned regarding losing a functioning adrenal gland. Tumor functional status and female gender were significant predictors of adrenal insufficiency at 30 days. A larger sample size would likely be necessary to identify other significant predictors given the low incidence of insufficiency.

Funding

none