Department of Endocrinology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
Endocrine Division, Tawam Hospital, Al Ain, United Arab Emirates.
Front Endocrinol (Lausanne). 2021 May 11;12:654600. doi: 10.3389/fendo.2021.654600. eCollection 2021.
Cortisol levels in response to stress are highly variable. Baseline and stimulated cortisol levels are commonly used to determine adrenal function following unilateral adrenalectomy. We report the results of synacthen stimulation testing following unilateral adrenalectomy in a tertiary referral center.
Data were collected retrospectively for 36 patients who underwent synacthen stimulation testing one day post unilateral adrenalectomy. None of the patients had clinical signs of hypercortisolism preoperatively. No patient received pre- or intraoperative steroids. Patients with overt Cushing's syndrome were excluded.
The median age was 58 (31-79) years. Preoperatively, 16 (44%) patients had a diagnosis of pheochromocytoma, 12 (33%) patients had primary aldosteronism and 8 (22%) patients had non-functioning adenomas with indeterminate/atypical imaging characteristics necessitating surgery. Preoperative overnight dexamethasone suppression test results revealed that 6 of 29 patients failed to suppress cortisol to <50 nmol/L. Twenty (56%) patients achieved a stimulated cortisol ≥450 nmol/L at 30 minutes and 28 (78%) at 60 minutes. None of the patients developed clinical adrenal insufficiency necessitating steroid replacement.
Synacthen stimulation testing following unilateral adrenalectomy using standard stimulated cortisol cut-off values would wrongly label many patients adrenally insufficient and may lead to inappropriate prescriptions of steroids to patients who do not need them.
应激状态下的皮质醇水平变化很大。基础和激发皮质醇水平常用于单侧肾上腺切除术后评估肾上腺功能。我们报告了在一家三级转诊中心进行单侧肾上腺切除术后使用促肾上腺皮质激素兴奋试验的结果。
对 36 例单侧肾上腺切除术后一天进行促肾上腺皮质激素兴奋试验的患者进行回顾性数据分析。所有患者术前均无皮质醇增多症的临床征象。没有患者接受术前或术中皮质激素治疗。排除有明显库欣综合征的患者。
中位年龄为 58（31-79）岁。术前，16 例（44%）患者诊断为嗜铬细胞瘤，12 例（33%）患者为原发性醛固酮增多症，8 例（22%）患者为无功能腺瘤，影像学表现不确定/不典型，需要手术。术前 overnight 地塞米松抑制试验结果显示，29 例中有 6 例未能将皮质醇抑制到<50 nmol/L 以下。20 例（56%）患者在 30 分钟时皮质醇刺激达到≥450 nmol/L，28 例（78%）在 60 分钟时达到该水平。没有患者出现需要类固醇替代治疗的临床肾上腺功能不全。
单侧肾上腺切除术后使用标准的皮质醇激发值进行促肾上腺皮质激素兴奋试验可能会错误地将许多患者标记为肾上腺功能不全，并可能导致不必要地给不需要的患者开类固醇处方。
