Adrenal function after adrenalectomy for subclinical hypercortisolism and Cushing’s syndrome: a systematic review of the literature
Abstract
CONTEXT: The postoperative course of patients with subclinical hypercortisolism (SH) is yet to be clarified. The aims are to review the prevalence and predictive factors of postoperative adrenal insufficiency and the time to recover a normal adrenocortical function in patients with SH and Cushing's syndrome (CS). EVIDENCE ACQUISITION: Using the PubMed database, we conducted a systematic review of the literature, selecting studies published from 1980 to 2013. EVIDENCE SYNTHESIS: Of the 1522 papers screened, 28 were selected (13 retrospective, 14 prospective, and one randomized controlled trial). The prevalence of postoperative adrenal insufficiency was 65.3% in 248 SH subjects and 99.7% in 377 CS patients. Patients with SH were reclassified according to the following diagnostic criteria: subjects defined by pathological dexamethasone test only (DEX), and those defined by the dexamethasone test with one (DEX+1) or two additional criteria (DEX+2); and they were compared with CS patients. The prevalence of adrenal insufficiency was 51.4, 60.6, 91.3, and 99.7%, respectively, with no significant difference between the two latter groups. The test with the best compromise between sensitivity (64%) and specificity (81%) in predicting adrenal insufficiency was the midnight serum cortisol. The time to achieve eucortisolism was lower in SH patients than in CS patients (6.5 vs 11.2 mo; P < .001). CONCLUSIONS: Adrenal insufficiency occurs in about half of the patients with SH if defined only by the pathological dexamethasone test. However, prevalence of adrenal insufficiency and time to recovery are tightly related to the degree of hypercortisolism and diagnostic criteria to define SH, which might help to better define SH for future studies.
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Even though treatment regimens, route of administration, potency, dose, duration of glucocorticoid treatment, as well as individual glucocorticoid sensitivity, have been postulated as potential risk factors for glucocorticoid-induced AI, no clear-cut predictive factors of risk of onset and duration of AI before HPA axis recovery have been identified so far.
“Even though treatment regimens, route of administration, potency, dose, duration of glucocorticoid treatment, as well as individual glucocorticoid sensitivity, have been postulated as potential risk factors for glucocorticoid-induced AI, no clear-cut predictive factors of risk of onset and duration of AI before HPA axis recovery have been identified so far (15, 16, 20, 21).”
From The Changing Face of Drug-induced Adrenal Insufficiency in the Food and Drug Administration Adverse Event Reporting System (2022) · cites this paper as [21]
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Self-citation
- Authors
- Di Dalmazi, G., Berr, C. M., Fassnacht, M., Beuschlein, F., & Reincke, M.
- Affiliations
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, D-80336 München, Germany
- LMU Klinikum (DE)
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2014-08-01
- Volume
- 99
- Issue
- 8
- Pages
- 2637-2645
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2048388708
- Cited by
- 139
- References
- 13
- Citations by year
- 2026: 6 · 2025: 16 · 2024: 15 · 2023: 11 · 2022: 13 · 2021: 18 · 2020: 15 · 2019: 7 · 2018: 13 · 2017: 8 · 2016: 11 · 2015: 6
- FWCI
- 1.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Funders
- Department of Science and Technology, Ministry of Science and Technology, India
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Keywords
- subclinical hypercortisolism, Cushing's syndrome, adrenalectomy, postoperative adrenal insufficiency, dexamethasone suppression test
- MeSH terms
- Adrenal Insufficiency, Adrenal Glands, Adrenalectomy, Cushing Syndrome, Humans, Postoperative Complications, Prevalence, Asymptomatic Diseases
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