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
The importance of postoperative control: adrenal insufficiency after unilateral adrenalectomy for Conn’s syndrome. A case study