Predicting postoperative hypocortisolism in patients with non-aldosterone-producing adrenocortical adenoma: a retrospective single-centre study

• DOI: 10.1007/s40618-023-02283-1
• Publication Date: 2024-02-22T12:20:44Z
• Authors: I. Bonaventura; A. Tomaselli; F. Angelini; D. Ferrari; D. De Alcubierre; V. Hasenmajer; E. Sbardella; A. Cozzolino; A. M. Paganini; A. M. Isidori; M. Minnetti; R. Pofi
• Keywords: Dexamethasone suppression test; Incidentaloma; Adrenocortical adenoma; Cosyntropin; ACTH stimulation test; Adrenal adenoma

Abstract Background Limited information exists on postoperative hypocortisolism and hypothalamus–pituitary–adrenal axis recovery in patients with adrenal incidentaloma following unilateral adrenalectomy. We evaluated frequency of predictors for non-aldosterone-producing adrenocortical adenoma after Methods A retrospective analysis 32 originally included the ITACA trial (NCT04127552) confirmed undergoing adrenalectomy from September 2019 to April 2023 was conducted. Preoperative assessments MRI, anthropometrics, evaluation comorbidities, function assessed via ACTH, urinary free cortisol, 1 mg dexamethasone suppression test. ACTH serum cortisol or Short Synacthen test were performed within 6 days, weeks, months, a year surgery. Results Six days postoperative, 18.8% had normal function. Among those hypocortisolism, 53.8% recovered by weeks. Patients earlier (6 weeks) lower preoperative (median 76.2 [61.8–111.0] nmol/L vs 260.0 [113.0–288.5] nmol/L, p < 0.001). Univariate showed negatively related baseline levels ( r = − 0.376; 0.041) associated 6-week 0.395, 0.034) 30-min during 0.534, 0.023). Logistic regression demonstrated as only biochemical predictor recovery: ROC curve identified threshold 131 predicting 89.5% sensitivity 72.7% specificity (AUC 0.87; 95% CI 66.9–98.7, Other (tumor size, anthropometrics) not function, but presence diabetes probability (OR 24.55, 0.036). increased postoperatively all did predict recovery. Conclusions The value are relevant non-aldosterone- producing surgery, regardless other clinical variables. Notably, pre- These findings point towards potential saving resources optimizing their allocation follow-up