Steroid replacement after adrenalectomy for mild autonomous cortisol secretion: Clinical predictors and a practical...

Area of Science:

• Endocrinology
• Surgical Oncology

Background:

• Mild autonomous cortisol secretion (MACS) affects up to 50% of patients with adrenal nodules.
• Postoperative steroid replacement guidelines for MACS after adrenalectomy remain unclear.

Purpose of the Study:

• To determine the frequency of postoperative steroid replacement in patients with MACS undergoing unilateral adrenalectomy.
• To identify clinical predictors for steroid replacement in these patients.

Main Methods:

• Retrospective study of 139 patients with MACS undergoing unilateral adrenalectomy (2000-2024).
• MACS defined as serum cortisol >1.8 μg/dL post-low-dose dexamethasone suppression without Cushing syndrome.
• Steroid replacement decisions based on postoperative cortisol levels, ACTH stimulation tests, and clinical signs of adrenal insufficiency.

Main Results:

• Only 23% of patients required postoperative steroid replacement.
• Independent predictors for steroid replacement included low preoperative plasma ACTH (<7.0 pg/mL) and high LDDST cortisol (>4.2 μg/dL).
• No evidence of adrenal insufficiency during a median 15-month follow-up; steroids weaned within a median of 78 days.

Conclusions:

• A safe algorithm for postoperative steroid management in MACS patients was established.
• This algorithm significantly reduced the need for steroid replacement compared to previous reports.
• This is the largest study to date on postoperative steroid management in MACS.