Key takeaways:
- Of adults who underwent an adrenalectomy for mild autonomous cortisol secretion, 54.4% developed adrenal insufficiency.
- More than half of those with adrenal insufficiency recovered within 6 months.
More than half of adults who underwent a unilateral adrenalectomy to treat mild autonomous cortisol secretion developed adrenal insufficiency, according to data published in The Journal of Clinical Endocrinology & Metabolism.
In a retrospective study of patients who underwent an adrenalectomy at five centers in the U.S., adrenal insufficiency was diagnosed in 54.4% of the study group after the procedure. Adrenal insufficiency was more likely to be diagnosed among younger adults, and 73% of diagnosed adults recovered in less than 1 year with glucocorticoid treatment.
Data were derived from Hamidi O, et al. J Clin Endocrinol Metab. 2025;doi:10.1210/clinem/dgaf515.
“The findings support the use of both postoperative cortisol testing — basal cortisol or cosyntropin stimulation test — to accurately diagnose adrenal insufficiency and guide glucocorticoid therapy,” Irina Bancos, MD, MSc, professor of medicine and adrenal lab principal investigator in the division of endocrinology, metabolism and nutrition at Mayo Clinic, and Oksana Hamidi, DO, MSCS, associate professor in the division of endocrinology at UT Southwestern Medical Center, told Healio. “This testing approach can help avoid unnecessary glucocorticoid exposure while ensuring patient safety.”
Researchers collected data from 281 adults aged 18 years or older diagnosed with mild autonomous cortisol secretion between January 2013 and August 2024 who underwent a unilateral adrenalectomy (80% women; median age, 57 years). Patients were deemed to have adrenal insufficiency if they received a clinical diagnosis based on symptoms and results from basal cortisol and cosyntropin stimulation testing, if they had a basal cortisol level of less than 10 µg/dL and a stimulated cortisol level on a cosyntropin stimulation test of less than 18 µg/dL. If there were discordant basal cortisol level and cosyntropin stimulation test results, the decision to initiate glucocorticoid therapy was made by the treating physician, taking into account the clinical context and individual patient factors.
Of the study group, 54.4% were diagnosed with postoperative adrenal insufficiency and treated with glucocorticoids. In multivariable analysis, every 10 years of older age reduced odds for an adrenal insufficiency diagnosis by 33% (OR = 0.67; 95% CI, 0.53-0.84).
Bancos and Hamidi said they were surprised at how strong the association was between age and adrenal insufficiency.
“The strong inverse relationship between age and risk of adrenal insufficiency observed in our study could suggest that younger patients may derive greater benefit from adrenalectomy for mild autonomous cortisol secretion,” Bancos and Hamidi said. “Younger patients also had higher dexamethasone suppression test cortisol and lower adrenocorticotropic hormone, reflective of more severe mild autonomous cortisol secretion.”
Of the participants, 60.1% had a low basal cortisol level of less than 10 µg/dL, and 57.6% had a reduced simulated cortisol level of less than 18 µg/dL. Basal and stimulated cortisol were concordant on adrenal insufficiency diagnoses for 78% of patients. Adults who had bilateral nodules were more likely to have discordant results between the cortisol tests than adults with a unilateral nodule (32% vs. 19%; P < .001).
Of adults diagnosed with adrenal insufficiency, 70.6% recovered during a median follow-up of 15.4 months. The proportion of diagnosed adults who recovered was 41% at 3 months, 60% at 6 months, 73% at 1 year and 84% at 18 months. Median recovery time was 3 months for adults with biochemically mild adrenal insufficiency, 4.7 months for those with moderate insufficiency and 14.5 months for adults with severe adrenal insufficiency (P = .02). Recovery times were similar when adrenal insufficiency severity was assessed through clinical severity score.
Bancos and Hamidi said the study findings emphasize the importance of conducting frequent postoperative testing for adrenal insufficiency, noting that regular testing can help avoid prolonged glucocorticoid exposure for patients.
“Early recovery is common,” Bancos and Hamidi said. “Delayed testing may lead to unnecessary glucocorticoid exposure and delay recovery.”
Additionally, Bancos and Hamidi said dexamethasone and other steroids should not be given to patients during an adrenalectomy or while administering anesthesia, as they may confound cortisol testing. They said endocrinologists should work with the anesthesia and surgical teams to optimize timing of postoperative cortisol testing.
For more information:
Irina Bancos, MD, MSc, can be reached at bancos.irina@mayo.edu.
Oksana Hamidi, DO, MSCS, can be reached at oksana.hamidi@utsouthwestern.edu.
