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Adrenal Insufficiency After Unilateral Adrenalectomy in Primary Aldosteronism: Long-Term Outcome and Clinical Impact
Journal article

Adrenal Insufficiency After Unilateral Adrenalectomy in Primary Aldosteronism: Long-Term Outcome and Clinical Impact

  • Heinrich, Daniel A ORCID Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
  • Adolf, Christian Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
  • Holler, Finn Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
  • Lechner, Benjamin Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
  • Schneider, Holger ORCID Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
  • Riester, Anna Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
  • Nirschl, Nina Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
  • Sturm, Lisa Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
  • Wang, Xiao Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
  • Ladurner, Roland ORCID Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Campus Innenstadt, Klinikum der Universität München, LMU München, Munich, Germany
  • Seidensticker, Max Klinik und Poliklinik für Radiologie, Klinikum der Universität München, LMU München, Munich, Germany
  • Bidlingmaier, Martin ORCID Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
  • Beuschlein, Felix ORCID Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitäts-Spital Zürich, Zurich, Switzerland
  • Reincke, Martin ORCID Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
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  • 2019-6-21
Published in:
  • The Journal of Clinical Endocrinology & Metabolism. - The Endocrine Society. - 2019, vol. 104, no. 11, p. 5658-5664
Clinical Biochemistry
Biochemistry
Endocrinology, Diabetes and Metabolism
Endocrinology
Biochemistry, medical
English Abstract

Context
Primary aldosteronism (PA) represents a secondary form of arterial hypertension that can be cured by surgery. Evidence of adrenal insufficiency (AI) was recently found in patients with PA who had undergone unilateral adrenalectomy (uADX).


Objective
To study the incidence and long-term outcome of postoperative AI after uADX for PA.


Design
Prospective registry study (August 2014 until the end of 2018).


Setting
Tertiary referral center.


Patients
One hundred consecutive patients undergoing uADX for PA were included. All patients underwent postoperative ACTH stimulation testing.


Intervention
Postoperative ACTH stimulation testing to identify patients with AI.


Main Outcome Measures
Incidence of patients with postoperative AI and definition of long-term outcome.


Results
Twenty-seven percent of patients developed postoperative AI. Of these, 48% had postoperative ACTH stimulation serum cortisol levels ≤13.5 µg/dL (severe AI); 52% were classified into the group with moderate AI (stimulated serum cortisol levels: 13.5 to 17 µg/dL). Patients with severe AI required significantly longer hydrocortisone replacement therapy than the moderate group (median [25th, 75th percentiles]: 353 [294, 476] days; 95% CI: 284 to 322 days; vs 74 [32, 293] days; 95% CI: 11 to 137 days; P = 0.016). One patient with severe AI was hospitalized for an acute adrenal crisis. With a cumulative follow-up of 14.5 years, this produced an incidence rate of 6.9 adrenal crises per 100 patient-years.


Conclusion
We suggest performing postoperative ACTH stimulation tests in all patients who undergo uADX for PA.
Language
  • English
Open access status
closed
Identifiers
Persistent URL
https://sonar.ch/global/documents/218095
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