Abstract
Cushing's syndrome requires glucocorticoid replacement following adrenalectomy. Based on a simplified glucocorticoid therapy scheme and the peri-operative observation, we investigated its efficacy and safety up to 6 months post-adrenalectomy in this cohort study.We found the adrenocorticotropic hormone (ACTH) levels were normal post-adrenalectomy, and sufficient to stimulate the recovery of the dystrophic adrenal cortex, thus exogenous supplemental ACTH might not be necessary.Patients were grouped by oral reception of either hydrocortisone or prednisone since day 2 post-adrenalectomy. Both groups had similar baseline responses to adrenalectomy, regarding the correction of hypertension (10/15 vs.12/19), hyperglycemia (6/11 vs. 7/10), and hypokalemia (12/12 vs. 11/11). Most patients lost weight (17/20 vs. 20/22). Both groups reported significant improvement in a subjective evaluation questionnaire. Hydrocortisone showed advantages over prednisone in improving liver function (7/8 vs. 2/7, p = 0.035), but also caused significant lower extremety edema (p = 0.034).Both groups developed adrenal insufficiency (AI) during glucocorticoid withdrawal, with no significant difference regarding the incidence rate (7/20 vs. 10/22) or severity. Most AI symptoms were relieved by resuming the prior oral doses, while two severe cases were hospitalized. The withdrawal process may last longer time for hydrocortisone than prednisone.In conclusion, our data supports the use of both hydrocortisone and prednisone in the glucocorticoid replacement therapy post-adrenalectomy for patients of adrenal adenoma or Cushing's disease. Hydrocortisone showed advantages over prednisone in improving liver function, and prednisone exhibited significantly lower risk of edema.
Highlights
The symptoms of Cushing’s syndrome can be largely related to mineralocorticoid produced by zona glomerulosa, glucocorticoid secreted by zona fasciculata, and sexual corticoid produced by zona seticularis
The adrenocorticotropic hormone (ACTH) level of Cushing's disease (CD) patients was still pathologically high (380.6 ± 136.0 pg/ml by 6 months), it started to recover in adrenal adenoma patients after adrenalectomy (25.2 ± 11.3 pg/ml by 6 months)
Despite the completely different pathology of CD and adrenocortical adenoma, both diseases exhibit the overproduction of corticoid and subsequent symptoms
Summary
The symptoms of Cushing’s syndrome can be largely related to mineralocorticoid produced by zona glomerulosa, glucocorticoid secreted by zona fasciculata, and sexual corticoid produced by zona seticularis. Hydrocortisone has been widely used for a long time, it is yet less prescribed in China, probably due to problems in its domestic availability and high cost of the oral tablet Such prescription preference is seen in the hormone replacement therapy of other diseases. In UK, 20% female and 39% male CAH patients are on hydrocortisone, while prednisolone covers 49% female and 29% male patients respectively [7] As both hydrocortisone and prednisone have demonstrated their efficacy in decades of practice, few studies have compared them directly to address whether one has significant advantages over the other [8]. We included both Cushing’s syndrome patients on hydrocortisone and prednisone in our study for comparison
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