Endocrine Abstracts

Introduction: Laparoscopic unilateral adrenalectomy (UA) is a frequent approach in managing patients with structural and functional adrenal disorders. Suboptimal assessment post-operatively can result in multiple adverse consequences, including adrenal insufficiency. However, the optimal post-operative assessment and long-term effects on physical and mental health have not been sufficiently documented. This study aims to investigate the long-term effects of UA on the health-related quality of life (HRQoL) of patients with adrenal pathologies.

Methodology: For this retrospective audit, we identified patients who had undergone the procedure for endocrine and non-endocrine indications over the last seven years. All eligible candidates were contacted by telephone and invited to participate in this HRQoL survey. We used the 12-Item Survey (SF-12) to evaluate the scores of the physical- (PC) and mental-health components (MC). Moreover, participants were asked for information regarding the intake of steroids after the surgery.

Results: We audited 163 patients, 18 were reported as deceased and 75 agreed to participate. The most common PC-complaints were limitations in what they accomplished (42.7%) and their physical activities (38.7%). Regarding MC, only 36% felt they accomplished less than desired, with 48% reporting variable feelings of depression. The HRQoL scores differed according to the indication for surgery (phaeochromocytoma vs incidentaloma vs adrenal-related malignancy, MC: 49.2±13.0 vs 48.5±13.6 vs 43.6±17.8, P-value=0.679 and PC: 47.3±9.6 vs 38.5±12.9 vs 44.2±7.6, P-value=0.089). Patients operated for phaeochromocytoma had better PC scores than those operated for adrenal incidentaloma (P-value=0.031). We also found a difference in steroid requirements post-operatively, comparing phaeochromocytoma vs adrenal incidentaloma patients (post-op steroid use, permanent 0% vs 36.8%, never 100% vs 63.2%, p value=0.017).

Conclusion: In order to better improve health outcomes for UA patients, adopting a multidisciplinary approach is required not only for optimal HRQoL post-surgery, but also to ensure optimal steroid use when needed.