Glucocorticoid replacement duration after unilateral adrenalectomy for mild autonomous cortisol secretion and adrenal Cushing syndrome: a multicenter cohort study.

Lee YB, Park SS, Park MJ, +8 more, Lee SH.

Multicenter StudyAbstract only — full text under license

AI summary — for doctors, generated from the abstract only

After unilateral adrenalectomy, median HPA axis recovery took about 8 months for mild autonomous cortisol secretion and about 15 months for adrenal Cushing syndrome, with older age consistently delaying recovery.

What was studied

Retrospective multicentre cohort of 139 adults with MACS and 280 with adrenal CS requiring postoperative glucocorticoid replacement, analysed with Cox and RMST models.

Key findings

Median time to recovery: 8.2 months (MACS) vs 14.8 months (CS)
MACS: older age (HR 0.72 per 10 years) and post-DST cortisol >10.0 ug/dL delayed recovery; higher DHEAS ratio and ACTH hastened it
CS: older age (HR 0.74 per 10 years), higher HbA1c, and post-DST cortisol >7.9 ug/dL (+364 days) delayed recovery; higher ACTH hastened it

Clinical relevance

This helps clinicians counsel patients on expected glucocorticoid replacement duration after adrenalectomy and identify those likely to need prolonged replacement.

Who should care

Endocrinology

Limitations

Retrospective design; recovery defined by glucocorticoid discontinuation, which depends on local tapering practices.

Expect adrenal recovery to take months after surgery for cortisol-secreting adenomas, longer in older patients and in overt Cushing.

This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.

Abstract

Objective

Data on hypothalamic-pituitary-adrenal axis (HPAA) recovery after adrenalectomy are limited by small samples, heterogeneous criteria, and no distinction between mild autonomous cortisol secretion (MACS) and adrenal Cushing syndrome (CS). We investigated HPAA recovery duration and associated factors separately in MACS and adrenal CS.

Design

Retrospective, multicenter cohort.

Methods

We analyzed 139 adults with MACS and 280 with adrenal CS who underwent unilateral adrenalectomy and required postoperative glucocorticoid replacement. HPAA recovery was defined as discontinuation of glucocorticoids. Associated factors were evaluated using Cox proportional hazards models and restricted mean survival time (RMST) regression.

Results

The Kaplan-Meier-estimated median (95% confidence interval) time to recovery was 8.2 (6.5-9.7) months in MACS and 14.8 (13.2-16.3) months in adrenal CS. In MACS, older age [hazard ratio (HR) = 0.72 per 10 years; +94 days for >61 years, τ = 540 days] and cortisol after 1-mg overnight dexamethasone suppression test [post-overnight dexamethasone suppression test (ODST) cortisol] > 10.0 µg/dL (+113 days) were associated with delayed recovery, whereas higher dehydroepiandrosterone-sulfate ratio (HR = 1.50 per log-unit; -91 days for >0.61) and adrenocorticotropic hormone (ACTH) (HR = 1.61 per log-unit) were associated with faster recovery. In adrenal CS, older age (HR = 0.74 per 10 years; +198 days for >36 years, τ = 1095 days), higher glycated hemoglobin (HR = 0.81 per 1%), and post-ODST cortisol >7.9 µg/dL (+364 days) were associated with delayed recovery, whereas higher ACTH (HR = 1.27 per log-unit; -130 days for >5.1 pg/mL) was associated with faster recovery.

Conclusions

Older age was consistently associated with delayed recovery, while biochemical markers contributed differentially by disease subtypes.

DOI

10.1093/ejendo/lvag172

PMID

42687777

Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.

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