TY - JOUR
AR - IJSCR-2019-2-108
TI - The Incidence of Long-Term Adrenal Insufficiency Following Unilateral Adrenalectomy is Low: Case Series and Review of Literature
AU - Augustyna, Gogoj
AU - Brian D., Saunders
AU - Daniel, J.Canter
AU - Jay D., Raman
AU - Jeffrey, B. Walker
AU - Justin, Loloi
AU - Kathleen, Lehman
JO - International Journal of Surgical Case Reports
PY - 2019
DA - Mon 23, Dec 2019
SN - 2674-4171
DO - http://dx.doi.org/10.31487/j.IJSCR.2019.02.08
UR - https://www.sciencerepository.org/the-incidence-of-long-term-adrenal-insufficiency-following-unilateral-adrenalectomy-is-low-case-series-and-review-of-literature_IJSCR-2019-2-108 
KW - Adrenalectomy, adrenal insufficiency, steroid supplementation, cortisol
AB - Introduction: Acquired adrenal insufficiency is a known risk of unilateral adrenalectomy. However, the
rates of early and prolonged adrenal insufficiency following unilateral adrenalectomy are not well defined
in the literature.
Patients and Methods: We reviewed a case series of 184 consecutive patients to determine the likelihood
of steroid supplementation at 30 days and 1 year following adrenalectomy. 109 lesions were non-functional
and 75 (41%) demonstrated functionality, including 33 pheochromocytomas, 20 cortisol-producing
adenomas, 19 aldosteronomas, and 3 cases of cortisol-secreting hyperplasia. No patients with a nonfunctional lesion, pheochromocytoma, or aldosteronoma required steroid supplementation following
surgery. Eleven of 23 patients (48%) with primary adrenal Cushing syndrome required cortisol
supplementation at 30 days, and only 1 patient (4%) necessitated supplementation one year following
surgery.
Discussion: Approximately 50% of patients with cortisol-producing lesions in the adrenal gland will require
supplementation 30-days following surgery. Only 4% will require persistent exogenous steroids at 1-year.
Conversely, less than 1% of patients with different types of functional or non-functional tumors required
supplementation after surgery.
Conclusion: The incidence of adrenal insufficiency following unilateral adrenalectomy is low. A large
majority of patients requiring steroid supplementation 30 days following surgery are able to wean off this
requirement by 1 year. With this information, we can better counsel our patients and set clearer expectations
for the potential need of cortisol supplementation following adrenalectomy