Perioperative steroid management for patients undergoing unilateral adrenalectomy for autonomous cortisol secreting adrenal adenoma

Thomos Payne; Sheryans Darla; Melanie Maxwell; David Manson-Bahr; Mark Rochester; Neetha Joseph; Janak Saada; Rupa Ahluwalia; Myint Khin Swe

doi:10.1530/endoabs.109.P29

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Endocrine Abstracts (2025) 109 P29 | DOI: 10.1530/endoabs.109.P29

SFEBES2025 Poster Presentations Adrenal and Cardiovascular (61 abstracts)

Perioperative steroid management for patients undergoing unilateral adrenalectomy for autonomous cortisol secreting adrenal adenoma

Thomos Payne ¹ , Sheryans Darla ¹ , Melanie Maxwell ¹ , David Manson-Bahr ¹ , Mark Rochester ¹ , Neetha Joseph ¹ , Janak Saada ¹ , Rupa Ahluwalia ¹ & Khin Swe Myint ^1,2

Author affiliations

¹Norfolk and Norwich University Hospital, Norwich, United Kingdom; ²University East Anglia, Norwich, United Kingdom

Background and rationale: Autonomous cortisol secretion (ACS) has become a distinctive clinical condition without clinical feature of Cushing’s syndrome but significantly associated with metabolic complications and adrenalectomy can improve biochemical and clinical parameters. Guidelines suggest prescribing steroid perioperatively until ‘recovery of the HPA axis’. A dose of intravenous dexamethasone is also given routinely during general anaesthesia for post-operative nausea. However, short term steroid therapy was not without risk. In our centre, we have started adopting an MDT tailored approach and some treated without perioperative steroid. 9am serum cortisol was checked at day 1 post operative period for those cases. A close clinical monitoring for potential hypoadrenalism was observed.

Methods: Retrospectively, we reviewed our ACS management from 2016-2024. The terms ‘autonomous cortisol secretion’ and ‘adrenalectomy’ were searched. Detailed investigation for cortisol excess, cardiovascular disease risk factors, review of anaesthetic charts, post-operative adrenal function testing results were recorded.

Results: We identified 80 patients who failed dexamethasone suppression test (mean cortisol 112.8nmol/l). Among them, 13 patients ((hypertension(n = 10), diabetes(n = 10), Other CVD risk (6), osteoporosis(n = 7)) underwent adrenalectomy. With MDT approach, perioperative steroid therapy was not given in 8 patients (61%), 6 had cortisol >300nmol/l at 9am on day 1 post-op. 2 patients had lower cortisol (275 and 210nmol/l), subsequent same day short synacthen test(SST) excluded hypoadrenalism (peak cortisol 612 and 551nmol/l). 5 patients (87%) who were given steroid had normal SST at first post op follow-up. All patients were cured (Post-operative dexamethasone suppression test with cortisol of <50nmol/l).

Conclusions: We demonstrated that sparing use of steroid in ACS perioperatively was safe. Performing a 9am cortisol at day 1 post-op is essential to prevent potential adrenal insufficiency. We have reduced steroid burden especially for those with diabetes as well as the need for outpatient SST. Further validation with larger numbers is required.