The utility of cosyntropin stimulation test in the assessment of adrenal function after unilateral adrenalectomy.

IF 3.2 2区医学 Q1 SURGERY

Surgery Pub Date : 2026-09-01 DOI:10.1016/j.surg.2026.110585

Dogukan Akkus, Edip Memisoglu, Kamran Huseynli, Arturan Ibrahimli, Rafael Perez-Soto, Pratibha Rao, Riccardo Correa, Eren Berber

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引用次数: 0

Abstract

Background: There are scant data in the literature regarding assessment of adrenal function after unilateral adrenalectomy. Most research has involved patients with mild autonomous cortisol secretion, with recommendations to use the cosyntropin stimulation test and basal cortisol to diagnose secondary adrenal insufficiency. Our aim was to investigate the utility of the cosyntropin stimulation test in the assessment of adrenal function after unilateral adrenalectomy.

Methods: This was a retrospective institutional review board-approved study of patients who underwent unilateral adrenalectomy between 2010 and 2025, followed by basal morning cortisol and a cosyntropin stimulation test on postoperative day 1. The relationship between postoperative day 1 cortisol and the cosyntropin stimulation test was investigated.

Results: There were 179 patients with mild autonomous cortisol secretion and 119 with non-cortisol-secreting tumors. The cosyntropin stimulation test was normal when postoperative day 1 cortisol was >10 μg/dL in both groups. When postoperative day 1 cortisol was less than 5 mg/dL, the cosyntropin stimulation test was abnormal in 75% of patients in the mild autonomous cortisol secretion group and in 27% in the non-cortisol-secreting tumor group. When postoperative day 1 cortisol was 5-10 mg/dL, the cosyntropin stimulation test was abnormal in 38% of patients in the mild autonomous cortisol secretion group and 12% in the non-cortisol-secreting tumor group.

Conclusion: Routine postoperative day 1 morning cortisol followed by a selective cosyntropin stimulation test may enable a patient-custom assessment of adrenal insufficiency and minimize unnecessary steroid replacement after unilateral adrenalectomy. The most practical use of the cosyntropin stimulation test seems to be in patients with postoperative day 1 cortisol levels between 5 and 10 mg/dL.

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共syntropin刺激试验在单侧肾上腺切除术后肾上腺功能评估中的应用。

背景：关于单侧肾上腺切除术后肾上腺功能评估的文献资料很少。大多数研究涉及轻度自主皮质醇分泌的患者，建议使用共syntropin刺激试验和基础皮质醇来诊断继发性肾上腺功能不全。我们的目的是探讨共syntropin刺激试验在评估单侧肾上腺切除术后肾上腺功能的效用。方法：这是一项回顾性机构审查委员会批准的研究，研究对象是2010年至2025年间接受单侧肾上腺切除术的患者，随后在术后第1天进行基础早晨皮质醇和共syntropin刺激试验。观察术后第1天皮质醇水平与共syntropin刺激试验的关系。结果：轻度自主皮质醇分泌患者179例，非皮质醇分泌肿瘤119例。术后第1天皮质醇水平为bbb10 μg/dL时，两组共syntropin刺激试验正常。术后第1天皮质醇低于5 mg/dL时，轻度自主皮质醇分泌组75%的患者和非皮质醇分泌肿瘤组27%的患者共syntropin刺激试验异常。术后第1天皮质醇为5 ~ 10 mg/dL时，轻度自主皮质醇分泌组38%的患者和非皮质醇分泌肿瘤组12%的患者共syntropin刺激试验异常。结论：术后第1天早晨常规皮质醇与选择性共syntropin刺激试验可以使患者自定义评估肾上腺功能不全，并减少单侧肾上腺切除术后不必要的类固醇替代。cosyntropin刺激试验最实际的应用似乎是术后第1天皮质醇水平在5 - 10mg /dL之间的患者。

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来源期刊

Surgery 医学-外科

CiteScore

5.40

自引率

5.30%

发文量

687

审稿时长

64 days

期刊介绍： For 66 years, Surgery has published practical, authoritative information about procedures, clinical advances, and major trends shaping general surgery. Each issue features original scientific contributions and clinical reports. Peer-reviewed articles cover topics in oncology, trauma, gastrointestinal, vascular, and transplantation surgery. The journal also publishes papers from the meetings of its sponsoring societies, the Society of University Surgeons, the Central Surgical Association, and the American Association of Endocrine Surgeons.