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Adrenal insufficiency after unilateral adrenalectomy in primary aldosteronism - long-term outcome and clinical impact


Heinrich, Daniel A; Adolf, Christian; Holler, Finn; Lechner, Benjamin; Schneider, Holger; Riester, Anna; Nirschl, Nina; Sturm, Lisa; Wang, Xiao; Ladurner, Roland; Seidensticker, Max; Bidlingmaier, Martin; Beuschlein, Felix; Reincke, Martin (2019). Adrenal insufficiency after unilateral adrenalectomy in primary aldosteronism - long-term outcome and clinical impact. Journal of Clinical Endocrinology & Metabolism, 104(11):5658-5664.

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 PA patients that had undergone unilateral adrenalectomy (uADX).
OBJECTIVE
To study the incidence and long-term outcome of post-operative AI after uADX for PA.
DESIGN
Prospective registry study (2014 until end of 2018).
SETTING
Tertiary referral center.
PATIENTS
100 consecutive patients undergoing uADX for PA were included. All patients underwent post-operative ACTH stimulation testing.
INTERVENTION
Post-operative ACTH stimulation testing to identify AI patients.
MAIN OUTCOME MEASURE(S)
Incidence of post-operative AI patients and definition of long-term outcome.
RESULTS
27% of patients developed post-operative AI. Out of these, 48% had post ACTH stimulation serum cortisol levels ≤ 13.5 µg/dl (severe adrenal insufficiency). 52% were classified into the group of moderate adrenal insufficiency (stimulated serum cortisol: 13.5 - 17 µg/dl). Patients with severe AI required significantly longer hydrocortisone replacement therapy than the moderate group (median 353 days [294; 476], 95% CI: 284 - 322 vs. 74 days [32; 293], 95% CI: 11 - 137; 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 accounts to an incidence rate of 6.9 adrenal crises per 100 patient-years.
CONCLUSIONS
We suggest performing post-operative ACTH stimulation tests in all patients who undergo uADX for PA.

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 PA patients that had undergone unilateral adrenalectomy (uADX).
OBJECTIVE
To study the incidence and long-term outcome of post-operative AI after uADX for PA.
DESIGN
Prospective registry study (2014 until end of 2018).
SETTING
Tertiary referral center.
PATIENTS
100 consecutive patients undergoing uADX for PA were included. All patients underwent post-operative ACTH stimulation testing.
INTERVENTION
Post-operative ACTH stimulation testing to identify AI patients.
MAIN OUTCOME MEASURE(S)
Incidence of post-operative AI patients and definition of long-term outcome.
RESULTS
27% of patients developed post-operative AI. Out of these, 48% had post ACTH stimulation serum cortisol levels ≤ 13.5 µg/dl (severe adrenal insufficiency). 52% were classified into the group of moderate adrenal insufficiency (stimulated serum cortisol: 13.5 - 17 µg/dl). Patients with severe AI required significantly longer hydrocortisone replacement therapy than the moderate group (median 353 days [294; 476], 95% CI: 284 - 322 vs. 74 days [32; 293], 95% CI: 11 - 137; 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 accounts to an incidence rate of 6.9 adrenal crises per 100 patient-years.
CONCLUSIONS
We suggest performing post-operative ACTH stimulation tests in all patients who undergo uADX for PA.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Endocrinology and Diabetology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:1 November 2019
Deposited On:05 Jul 2019 11:50
Last Modified:11 Oct 2019 01:05
Publisher:Oxford University Press
ISSN:0021-972X
OA Status:Closed
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1210/jc.2019-00996
PubMed ID:31225874

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