IS POSTOPERATIVE SUBSTITUTION WITH HYDROCORTISONE NECESSARY AFTER ADRENALECTOMY FOR PRIMARY ALDOSTERONISM?

Abstract

Objective: Concomitant cortisol secretion in primary aldosteronism (PA) has repeatedly been described. Recently, clinically significant adrenal insufficiency after adrenalectomy in subjects with PA has been described. In this study, we retrospectively searched for possible adrenal insufficiency in subjects who underwent adrenalectomy for PA and have measured cortisol in the early postoperative course. Design and Methods: We included subjects with confirmed diagnosis of PA who underwent either posture testing (blood draw at approximately 06:00 and 08:00) and/or adrenal venous sampling (AVS) (blood draw between 08:00 and 09:00) and have also measured cortisol after surgery (cortisol measured approximately at 07:00). Cortisol was measured by immunoassay. Design and method: We identified 110 subjects (age 49.5 ± 10.1 years) with available cortisol values in the early postoperative course (median [25th percentile, 75th percentile]) 6 [5, 6] days. Postoperative cortisol values (529 [431, 620] nmol/L) were significantly higher compared to preoperative standing cortisol values (388 [292, 482] nmol/L; (P < 0.005) and AVS cortisol values (472.5 [339, 615] nmol/L; P = 0.04), and did not significantly differ from preoperative supine cortisol values. The lowest cortisol value post-surgery was 292 nmol/L. Postsurgical cortisol values were not different among subjects with or without abnormal dexamethasone suppression test or elevated urinary free cortisol pre-surgery. Conclusion: Postoperative cortisol values did not indicate any suspicion of possible adrenal insufficiency. These values were significantly higher compared to preoperative standing or AVS cortisol values obtained approximately 1 hour later, which reflects postoperative stress on one hand and normal diurnal cortisol rhythmicity on the other hand.