Postoperative adrenal cortical insufficiency following adrenal adenoma removal: a case report

The adrenal gland is one of the important endocrine organs in the human body. With advancements in medical technology, the diagnosis rates of adrenal diseases, such as adrenal tumors and adrenal cortical hyperplasia, have been steadily increasing. Surgical intervention is the mainstream method for treating adrenal tumors; however, unilateral complete adrenalectomy may impair the patient's adrenal cortical function, leading to adrenal insufficiency (AI). AI is caused by a deficiency of glucocorticoids, which may be accompanied or not accompanied by reductions in mineralocorticoids and sex hormones. The clinical manifestations can be prolonged and nonspecific, sometimes resulting in misdiagnosis and mistreatment. Adrenal venous sampling (AVS) is typically one of the diagnostic methods used to determine the presence of a functioning adrenal adenoma. After unilateral adrenalectomy for a functioning adrenal adenoma, AI may occur. Here, we summarize a case of a patient with a functioning adrenal adenoma who developed AI following unilateral adrenalectomy.

Here, we report a case of AI following unilateral adrenalectomy. The patient is a 28-year-old woman with a 2-year history of hypertension and a right adrenal mass that had been detected for more than 3 months. An abdominal computed tomography (CT) scan suggested a mass in the right adrenal gland. Preoperative AVS indicated elevated levels of aldosterone and cortisol in the right adrenal vein. After thorough preoperative preparations, a laparoscopic right adrenalectomy was performed, and postoperative pathology confirmed an adrenal adenoma. After discharge, the patient experienced recurrent symptoms of nausea and vomiting. Upon returning to the hospital, blood tests revealed abnormally low levels of cortisol in the peripheral blood, suggesting AI. After receiving glucocorticoid treatment, her symptoms improved.

Primary AI is relatively rare in clinical practice, typically occurring after unilateral adrenal surgery. The clinical manifestations are nonspecific, which often leads to misdiagnosis and mistreatment. Preoperative AVS for hormone level assessment can assist in diagnosing the nature of a functioning adrenal adenoma and help prevent postoperative AI.