Predictability of hypoadrenalism occurrence and duration after adrenalectomy for ACTH-independent hypercortisolism

V. Morelli, L. Minelli, C. Eller-Vainicher, S. Palmieri, E. Cairoli, A. Spada, M. Arosio, I. Chiodini

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: To evaluate if the parameters of hypothalamic–pituitary–adrenal (HPA) axis activity could predict the occurrence and duration of post-surgical hypocortisolism (PSH) in patients with Cushing’s syndrome (CS) and with adrenal incidentaloma (AI). Methods: We studied 80 patients (54 females, age 53.3 ± 11 years), who underwent adrenalectomy for CS (17 patients) or for AI (53 patients). Before surgery, we measured adrenocorticotroph hormone (ACTH), urinary free cortisol (UFC) and serum cortisol after 1 mg dexamethasone suppression test (1 mg-DST) levels. After surgery, all patients were given a steroid replacement therapy, and PSH was searched after 2 months by a low-dose (1 µg, iv) corticotropin stimulation test, that was repeated every 6 months in PSH patients for at least 4 years. Results: The PSH occurred in 82.4 and 46% of CS and AI patients, respectively. In the whole sample and in AI patients separately considered, the PSH was independently predicted by the preoperative cortisol levels after 1 mg-DST, however, with a low (< 70%) accuracy. In AI patients the PSH occurrence was not ruled out even by the cortisol levels after 1 mg-DST lower than 1.8 μg/dL (50 nmol/L). In the 50% of CS patients and in 31% of AI patients the PSH lasted more than 18 months and in 35.7% of CS patients it persisted for more than 36 months. In AI patients, the PSH duration was not predictable by any parameter. However, a PSH duration of at least 12 months was significantly predicted before adrenalectomy (sensitivity 91.7%, specificity 41.2%, positive predictive value 52.4%, negative predictive value 87.5%, p = 0.05) by the presence of at least 2 out of low ACTH levels, increased UFC levels and cortisol levels after 1 mg-DST ≥ 3.0 µg/dL (83 nmol/L). Conclusion: The PSH occurrence and its duration are hardly predictable before surgery. All patients undergoing unilateral adrenalectomy should receive a steroid substitutive therapy.

Original languageEnglish
Pages (from-to)485-493
Number of pages9
JournalJournal of Endocrinological Investigation
Volume41
Issue number4
DOIs
Publication statusPublished - 2018

Fingerprint

Adrenal Insufficiency
Cushing Syndrome
Adrenalectomy
Hormones
Hydrocortisone
Dexamethasone
Steroids
Adrenal incidentaloma
Adrenocorticotropic Hormone

Keywords

  • Adrenal incidentalomas
  • Adrenalectomy
  • Hypocortisolism

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Predictability of hypoadrenalism occurrence and duration after adrenalectomy for ACTH-independent hypercortisolism. / Morelli, V.; Minelli, L.; Eller-Vainicher, C.; Palmieri, S.; Cairoli, E.; Spada, A.; Arosio, M.; Chiodini, I.

In: Journal of Endocrinological Investigation, Vol. 41, No. 4, 2018, p. 485-493.

Research output: Contribution to journalArticle

@article{d4968f74030e4a8891619fbb51e6719e,
title = "Predictability of hypoadrenalism occurrence and duration after adrenalectomy for ACTH-independent hypercortisolism",
abstract = "Objective: To evaluate if the parameters of hypothalamic–pituitary–adrenal (HPA) axis activity could predict the occurrence and duration of post-surgical hypocortisolism (PSH) in patients with Cushing’s syndrome (CS) and with adrenal incidentaloma (AI). Methods: We studied 80 patients (54 females, age 53.3 ± 11 years), who underwent adrenalectomy for CS (17 patients) or for AI (53 patients). Before surgery, we measured adrenocorticotroph hormone (ACTH), urinary free cortisol (UFC) and serum cortisol after 1 mg dexamethasone suppression test (1 mg-DST) levels. After surgery, all patients were given a steroid replacement therapy, and PSH was searched after 2 months by a low-dose (1 µg, iv) corticotropin stimulation test, that was repeated every 6 months in PSH patients for at least 4 years. Results: The PSH occurred in 82.4 and 46{\%} of CS and AI patients, respectively. In the whole sample and in AI patients separately considered, the PSH was independently predicted by the preoperative cortisol levels after 1 mg-DST, however, with a low (< 70{\%}) accuracy. In AI patients the PSH occurrence was not ruled out even by the cortisol levels after 1 mg-DST lower than 1.8 μg/dL (50 nmol/L). In the 50{\%} of CS patients and in 31{\%} of AI patients the PSH lasted more than 18 months and in 35.7{\%} of CS patients it persisted for more than 36 months. In AI patients, the PSH duration was not predictable by any parameter. However, a PSH duration of at least 12 months was significantly predicted before adrenalectomy (sensitivity 91.7{\%}, specificity 41.2{\%}, positive predictive value 52.4{\%}, negative predictive value 87.5{\%}, p = 0.05) by the presence of at least 2 out of low ACTH levels, increased UFC levels and cortisol levels after 1 mg-DST ≥ 3.0 µg/dL (83 nmol/L). Conclusion: The PSH occurrence and its duration are hardly predictable before surgery. All patients undergoing unilateral adrenalectomy should receive a steroid substitutive therapy.",
keywords = "Adrenal incidentalomas, Adrenalectomy, Hypocortisolism",
author = "V. Morelli and L. Minelli and C. Eller-Vainicher and S. Palmieri and E. Cairoli and A. Spada and M. Arosio and I. Chiodini",
year = "2018",
doi = "10.1007/s40618-017-0788-6",
language = "English",
volume = "41",
pages = "485--493",
journal = "Journal of Endocrinological Investigation",
issn = "0391-4097",
publisher = "Springer International Publishing",
number = "4",

}

TY - JOUR

T1 - Predictability of hypoadrenalism occurrence and duration after adrenalectomy for ACTH-independent hypercortisolism

AU - Morelli, V.

AU - Minelli, L.

AU - Eller-Vainicher, C.

AU - Palmieri, S.

AU - Cairoli, E.

AU - Spada, A.

AU - Arosio, M.

AU - Chiodini, I.

PY - 2018

Y1 - 2018

N2 - Objective: To evaluate if the parameters of hypothalamic–pituitary–adrenal (HPA) axis activity could predict the occurrence and duration of post-surgical hypocortisolism (PSH) in patients with Cushing’s syndrome (CS) and with adrenal incidentaloma (AI). Methods: We studied 80 patients (54 females, age 53.3 ± 11 years), who underwent adrenalectomy for CS (17 patients) or for AI (53 patients). Before surgery, we measured adrenocorticotroph hormone (ACTH), urinary free cortisol (UFC) and serum cortisol after 1 mg dexamethasone suppression test (1 mg-DST) levels. After surgery, all patients were given a steroid replacement therapy, and PSH was searched after 2 months by a low-dose (1 µg, iv) corticotropin stimulation test, that was repeated every 6 months in PSH patients for at least 4 years. Results: The PSH occurred in 82.4 and 46% of CS and AI patients, respectively. In the whole sample and in AI patients separately considered, the PSH was independently predicted by the preoperative cortisol levels after 1 mg-DST, however, with a low (< 70%) accuracy. In AI patients the PSH occurrence was not ruled out even by the cortisol levels after 1 mg-DST lower than 1.8 μg/dL (50 nmol/L). In the 50% of CS patients and in 31% of AI patients the PSH lasted more than 18 months and in 35.7% of CS patients it persisted for more than 36 months. In AI patients, the PSH duration was not predictable by any parameter. However, a PSH duration of at least 12 months was significantly predicted before adrenalectomy (sensitivity 91.7%, specificity 41.2%, positive predictive value 52.4%, negative predictive value 87.5%, p = 0.05) by the presence of at least 2 out of low ACTH levels, increased UFC levels and cortisol levels after 1 mg-DST ≥ 3.0 µg/dL (83 nmol/L). Conclusion: The PSH occurrence and its duration are hardly predictable before surgery. All patients undergoing unilateral adrenalectomy should receive a steroid substitutive therapy.

AB - Objective: To evaluate if the parameters of hypothalamic–pituitary–adrenal (HPA) axis activity could predict the occurrence and duration of post-surgical hypocortisolism (PSH) in patients with Cushing’s syndrome (CS) and with adrenal incidentaloma (AI). Methods: We studied 80 patients (54 females, age 53.3 ± 11 years), who underwent adrenalectomy for CS (17 patients) or for AI (53 patients). Before surgery, we measured adrenocorticotroph hormone (ACTH), urinary free cortisol (UFC) and serum cortisol after 1 mg dexamethasone suppression test (1 mg-DST) levels. After surgery, all patients were given a steroid replacement therapy, and PSH was searched after 2 months by a low-dose (1 µg, iv) corticotropin stimulation test, that was repeated every 6 months in PSH patients for at least 4 years. Results: The PSH occurred in 82.4 and 46% of CS and AI patients, respectively. In the whole sample and in AI patients separately considered, the PSH was independently predicted by the preoperative cortisol levels after 1 mg-DST, however, with a low (< 70%) accuracy. In AI patients the PSH occurrence was not ruled out even by the cortisol levels after 1 mg-DST lower than 1.8 μg/dL (50 nmol/L). In the 50% of CS patients and in 31% of AI patients the PSH lasted more than 18 months and in 35.7% of CS patients it persisted for more than 36 months. In AI patients, the PSH duration was not predictable by any parameter. However, a PSH duration of at least 12 months was significantly predicted before adrenalectomy (sensitivity 91.7%, specificity 41.2%, positive predictive value 52.4%, negative predictive value 87.5%, p = 0.05) by the presence of at least 2 out of low ACTH levels, increased UFC levels and cortisol levels after 1 mg-DST ≥ 3.0 µg/dL (83 nmol/L). Conclusion: The PSH occurrence and its duration are hardly predictable before surgery. All patients undergoing unilateral adrenalectomy should receive a steroid substitutive therapy.

KW - Adrenal incidentalomas

KW - Adrenalectomy

KW - Hypocortisolism

UR - http://www.scopus.com/inward/record.url?scp=85034227377&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85034227377&partnerID=8YFLogxK

U2 - 10.1007/s40618-017-0788-6

DO - 10.1007/s40618-017-0788-6

M3 - Article

AN - SCOPUS:85034227377

VL - 41

SP - 485

EP - 493

JO - Journal of Endocrinological Investigation

JF - Journal of Endocrinological Investigation

SN - 0391-4097

IS - 4

ER -