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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 |
This item is licensed under a Creative Commons License