Pattern of The Evolution of The Contralateral Adrenal Gland’s Function After Unilateral Adrenalectomy

Abstract

Introduction: The occurrence of an adrenal insufficiency post adrenalectomy usually attests of the success of the operative act. After the adrenalectomy, we could expect a compensatory secretion by the controlateral adrenal gland. However, the integrity of the residual function of the remaining gland depends on the initial secretory character of the mass and on its length. The aim of this study was to evaluate the residual function of the controlateral gland after a unilateral adrenalectomy. Method: This was a 13-month prospective study in Yaoundé Central Hospital. We included in the study, all patients who underwent an adrenalectomy. The adrenal function was assessed in preoperative by the measurement of 8am plasmatic cortisol after a dexamethasone suppression test, while in postoperative periods it was the measure of the baseline plasmatic cortisol at 8am. The latter was possibly completed with a stimulation test with Synacthene 0.25μg. The association between the variables was searched using the Fischer test. A significance threshold of 0.05 was adopted. Results: Seven patients (4 women and 3 men) underwent surgery indicated for an adrenal mass. Median age was 44,7 years [17 – 69 years]. The discovery mode was mainly weight gain (28.6 %) or unexplained weight loss (28.6 %). The median delay to diagnosis was 8months [8 days – 24 months]. In the preoperative period, the median cortisol level after dexamethasone suppression test was 329.9 ng/ml, amongst which 2/7 patients had hypercortisolism. The median values of normetanephrines and metanephrines were 7nmol/L and 71.4 nmol/L, respectively. Pathology described: corticosurrenalomas (2), adrenal adenomas (2), pheochromocytomas (2) and adrenalitis (1). In early postoperative, the median 8 h cortisol was 45.5 ng/ml [34.5-167.1ng/ml]. In late postoperative, the median cortisol value was 95 ng/ml, and strictly normal in 3/6 patients. There was no association between recovery of residual adrenal function and age, tumor size, initial preoperative cortisol value, treatment received preoperatively, and postoperative complications. Conclusion Adrenal insufficiency persists in almost half of the patients in late postoperative. Thus, hydrocortisone supplementation should be maintained as long as possible.