Trandafir Alexandra-Ioana, Carsote Mara, Florescu Alexandru-Florin
PhD Doctoral School, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania.
Department of Endocrinology, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania.
J Clin Med. 2025 Jul 23;14(15):5217. doi: 10.3390/jcm14155217.
One third of "non-functioning adrenal tumours" (NFAs) have mild autonomous cortisol secretion (MACS). An updated analysis of the hormonal biomarkers profile, including risk factors and the rate of post-surgery adrenal insufficiency (PSAI), the duration of restoring the normal adrenocortical function in MACS/NFA and potential impacts on clinical comorbidities. Comprehensive review based on PubMed search (January 2020-January 2025). The studies (n = 14) included 2623 patients (N = 1158 underwent unilateral adrenalectomy), aged 18-93 (mean = 57.49 years), with a female-to-male ratio = 1.54. Post-adrenalectomy (n = 9, N = 753) analysis: the PSAI risk correlated with the severity of baseline hypercortisolism. PSAI incidence: 50% of MAC. The rate after 4-6 weeks follow-up was 71.9% (adrenal Cushing's syndrome) vs. 50% (MACS) vs. 14.4% (NFA). PSAI duration was up to 35 months. Early PSAI diagnosis was reflected by post-operative cortisol assay on day 1 (cut-off ≤ 5 µg/dL) and an ACTH (Cosyntropin) stimulation test (CST) (cortisol cut-off ≤ 14 µg/dL). Pre-operatory PSAI predictors: higher serum cortisol-DST (1 mg dexamethasone testing) and lower baseline plasma ACTH (not all studies agreed). A stratified strategy is encouraged following a unilateral adrenalectomy in MACS; PSAI is expected in almost half of patients, with a potential improvement of hypertension. Serum cortisol assays serve as most useful biomarker as pre-operatory PSAI predictor (after DST) and, potentially, in addition with baseline ACTH. Post-surgery basal cortisol measurement (± CST) helps the decision of glucocorticoids replacement since first post-operative day and during follow-up, serial testing at 3 months is a useful tool.
三分之一的“无功能肾上腺肿瘤”（NFA）存在轻度自主性皮质醇分泌（MACS）。对激素生物标志物谱进行了更新分析，包括危险因素、术后肾上腺功能不全（PSAI）发生率、MACS/NFA中肾上腺皮质功能恢复正常的持续时间以及对临床合并症的潜在影响。基于PubMed搜索（2020年1月至2025年1月）进行全面综述。纳入的14项研究共2623例患者（其中1158例接受了单侧肾上腺切除术），年龄18 - 93岁（平均57.49岁），男女比例为1.54。肾上腺切除术后（9项研究，753例患者）分析：PSAI风险与基线皮质醇增多症的严重程度相关。PSAI发生率：MAC患者中为50%。4 - 6周随访后的发生率分别为71.9%（肾上腺库欣综合征）、50%（MACS）和14.4%（NFA）。PSAI持续时间长达35个月。术后第1天的皮质醇检测（临界值≤5μg/dL）和促肾上腺皮质激素（考的松）刺激试验（CST）（皮质醇临界值≤14μg/dL）可反映PSAI的早期诊断。术前PSAI预测因素：较高的血清皮质醇 - DST（1mg地塞米松试验）和较低的基线血浆促肾上腺皮质激素（并非所有研究都一致）。对于MACS患者，单侧肾上腺切除术后鼓励采用分层策略；几乎一半的患者预计会发生PSAI，高血压可能会有所改善。血清皮质醇检测作为术前PSAI预测指标（DST后）最为有用，可能的话，还可结合基线促肾上腺皮质激素。术后基础皮质醇测量（±CST）有助于从术后第一天起就决定是否进行糖皮质激素替代治疗，在随访期间，3个月时的系列检测是一个有用的工具。
