12529 Pre And Post-operative Evaluation And Outcomes After Adrenalectomy At A Tertiary Referral Center

Abstract

Abstract Disclosure: C. Hung: None. L.M. Fishbein: None. M.R. Clay: None. M.B. Albuja-Cruz: None. C. Raeburn: None. K. Kiseljak-Vassiliades: None. M.E. Wierman: None. Introduction: The prevalence of adrenal nodules has increased over time due to increased abdominal CT imaging. Laboratory evaluation to screen for hypercortisolism, primary aldosteronism, or pheochromocytoma is recommended depending on nodule appearance and clinical risk factors. Our aim was to retrospectively determine the preoperative hormonal workup prior to adrenalectomy and to identify the postoperative comorbidities as they relate to preoperative hypercortisolism. Methods: From May 2017-March 2023, 205 adrenalectomies were performed for adrenal nodules. Preoperative and postoperative comorbidities, medications, laboratory results, imaging and pathology were assessed up to 1 year post surgery. Patients were stratified by degree of hypercortisolism, based on 1 mg dexamethasone suppression test, into cortisol 1.8-5 μg/dL (DST 1.8-5) or cortisol >5 μg/dL (DST >5). Statistical analysis included Fischer’s exact test and two-sample proportion test. Results: Of 205 adrenalectomies, 51 patients had primary aldosteronism (24.9%), 51 had pheochromocytoma (24.9%), 23 had ACC (11.2%), 15 had non-functional adrenal adenomas (7.3%), and 65 had adenomas associated with hypercortisolism (31.7%)—42 with DST 1.8-5 (20.5%), 23 with DST >5 (11.2%). Preoperatively 9 (17.6%) patients with PA underwent 1 mg DST, while 54 (83.1%) patients with hypercortisolism (DST >1.8) had aldosterone measured. Overall, 183/205 patients (89.3%) had hypertension preoperatively. Of the patients with hypercortisolism (DST>1.8), 58 (89.2%) had hypertension, without a difference in prevalence between DST 1.8-5 and DST >5 groups. For those with abnormal DST, no significant reduction in hypertension was observed within 2 months following adrenalectomy, but at 1 year postop, prevalence was reduced (89.2% preop vs 71.9% postop, p=0.03). There was no significant reduction in the prevalence of type 2 diabetes (p=0.78), prediabetes (p=0.48), hyperlipidemia (p=0.33), osteoporosis (p=0.53), or osteopenia (p=0.67) at 1 year postop in those with hypercortisolism. After adrenalectomy, 42.9% patients in the DST1.8-5 and 73.9% in the DST >5 group were discharged on glucocorticoids. Many patients were lost to long-term follow up. In those remaining, at 1 year postop, 14.3% patients in the DST1.8-5 and 50% in the DST >5 group still required steroids for adrenal insufficiency. Conclusions Not all patients with adrenal nodules are being screened for excess hormone production. Hypercortisolism is prevalent in patients undergoing adrenalectomy. Preoperative workup is essential to identify these patients before surgery as adrenal insufficiency can persist postoperatively. Adrenalectomy for hypercortisolism is associated with a reduction in hypertension at 1 year postoperatively. Presentation: 6/3/2024