On the postoperative steroid replacement in patients with ACTH independent Cushing's Syndrome

Abstract

Objective To investigate the preoperative factors in influencing the postoperative steroid replacement in patients with ACTH-independent Cushing's syndrome.Methods One hundred and eighty-one patients with adrenal cortical adenoma underwent unilateral adrenalectomy from 2003 to 2013.All preoperative and postoperative follow-up clinical parameters were acquired and analyzed.Results All patients need glucocorticoid (GC) replacement during and after surgery.At the median follow-up of 32 months (14-64 months),104 patients withdrew the cortisone acetate replacement,with a median replacement duration of 12 months (6-15 months) and an average cumulative dosage of(8.12 ± 5.07) g.Spearman correlation analysis showed that the age at diagnosis was positively correlated with the duration of GC replacement therapy (r =0.250,P =0.010) as well as the cumulative dosage of GC(r=0.244,P =0.013).Multiple stepwise regression analysis indicated that age at diagnosis was the independent factor that influenced both the duration and cumulative dosage of postoperative cortisone acetate replacement(P＜0.05).Plasma ACTH levels gradually increased and peaked during the 9th month,there was a lag of several months in the recovery of normal adrenal responsiveness.After that period,corticosteroid rose to normal levels,and followed by plasma ACTH concentrations,which fell to normal.2.88％ (3/104) of the patients presented with steroid withdrawal syndrome (SWS).Most features of hypercortisolism resolved within 6 months after surgery.Conclusion An empirical experience in Ruijin hospital in using cortisol replacement therapy for patients with ACTH-independent Cushing's syndrome after unilateral adrenalectomy was herewith reported.The older patients tended to prolong the replacement therapy of steroids and thus had to deal with a larger cumulative dosage.We should be aware of the risk of development of SWS postoperatively. Key words: Cushing's syndrome ; Adrenalectomy ; Steroid replacement therapy ; Hypothalamic-pituitary-gonad axis