Introduction

Adrenal insufficiency after adrenalectomy in patients with cortisol secreting adenomas is potentially critical if not treated. Therefore, patients who undergo adrenalectomy for subclinical Cushing syndrome (SCS) require post-surgical glucocorticoid replacement treatment. By contrast, the total duration of steroid replacement is still controversial and varies among patients. Here we analyzed pre-treatment various factors potentially affecting the duration of post-surgical steroid replacement in patients after laparoscopic adrenalectomy for SCS.

Methods

This retrospective analysis included 66 patients who underwent unilateral laparoscopic adrenalectomy for SCS between March 2005 and May 2016 at Chiba University Hospital. Adrenal tumor and contralateral adrenal sizes together with various clinical factors were studied in association with the duration of post-surgical steroid replacement. Adrenal tumor and contralateral adrenal sizes were measured at the level of maximum size of adrenal glands using CT scan. Cox’s proportional hazard model was used for the statistical analysis.

Results

All 66 patients treated post-surgical steroid replacement after adrenalectomy. Median duration of the steroid treatment was 6 months. Median age of the patients was 59 years. Among 66 patients, 37 cases had left adrenal tumor and 29 cases had right tumor. Median size of the tumor was 26.5mm. Median operation time was 175 minutes. Only 1 case converted to open surgery. When assessing the duration of post-surgical steroid replacement, maximum tumor diameter (MTD) > 26.5mm (HR 1.92, P = 0.0493) and contralateral adrenal thickness (CAT) < 6.3mm (HR 4.38, P < 0.0001) were significant predictors of prolonged post-surgical steroid treatment on univariate analysis. On multivariate analysis, CAT < 6.3mm (HR 4.04, P < 0.0001)was the only independent predictive factor for the prolonged post-surgical steroid replacement.

Conclusions

Contralateral adrenal thickness was the significant predictive factor for the duration of post-surgical steroid replacement in SCS patients. Pre-surgical assessment in the imaging may help clinicians determine the total duration of steroid therapy after adrenalectomy.

Funding

none