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Synacthen stimulation test following unilateral adrenalectomy needs to be interpreted with caution

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Title: Synacthen stimulation test following unilateral adrenalectomy needs to be interpreted with caution
Authors: Zaman, S
Almazrouei, R
Sam, AH
DiMarco, AN
Todd, JF
Palazzo, FF
Tan, T
Dhillo, WS
Meeran, K
Wernig, F
Item Type: Journal Article
Abstract: Background: Cortisol levels in response to stress are highly variable. Baseline and stimulated cortisol levels are commonly used to determine adrenal function following unilateral adrenalectomy. We report the results of synacthen stimulation testing following unilateral adrenalectomy in a tertiary referral center. Methods: Data were collected retrospectively for 36 patients who underwent synacthen stimulation testing one day post unilateral adrenalectomy. None of the patients had clinical signs of hypercortisolism preoperatively. No patient received pre- or intraoperative steroids. Patients with overt Cushing’s syndrome were excluded. Results: The median age was 58 (31-79) years. Preoperatively, 16 (44%) patients had a diagnosis of pheochromocytoma, 12 (33%) patients had primary aldosteronism and 8 (22%) patients had non-functioning adenomas with indeterminate/atypical imaging characteristics necessitating surgery. Preoperative overnight dexamethasone suppression test results revealed that 6 of 29 patients failed to suppress cortisol to <50 nmol/L. Twenty (56%) patients achieved a stimulated cortisol ≥450 nmol/L at 30 minutes and 28 (78%) at 60 minutes. None of the patients developed clinical adrenal insufficiency necessitating steroid replacement. Conclusions: Synacthen stimulation testing following unilateral adrenalectomy using standard stimulated cortisol cut-off values would wrongly label many patients adrenally insufficient and may lead to inappropriate prescriptions of steroids to patients who do not need them.
Issue Date: 11-May-2021
Date of Acceptance: 28-Apr-2021
URI: http://hdl.handle.net/10044/1/89121
DOI: 10.3389/fendo.2021.654600
ISSN: 1664-2392
Publisher: Frontiers Media
Start Page: 1
End Page: 7
Journal / Book Title: Frontiers in Endocrinology
Volume: 12
Copyright Statement: © 2021 Zaman, Almazrouei, Sam, DiMarco, Todd, Palazzo, Tan, Dhillo, Meeran and Wernig. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Keywords: 1103 Clinical Sciences
1111 Nutrition and Dietetics
Publication Status: Published
Article Number: 654600
Online Publication Date: 2021-05-11
Appears in Collections:Department of Metabolism, Digestion and Reproduction
Faculty of Medicine



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