Influencing factors for adrenal insufficiency after adrenalectomy in patients with adrenal adenoma-type subclinical Cushing's syndrome and their predictive efficiency
Objective To explore the influencing factors for adrenal insufficiency after adrenalectomy in patients with adrenal adenoma-type subclinical Cushing's syndrome(SCS)and to analyze the predictive efficacy of relevant influ-encing factors on postoperative adrenal insufficiency.Methods Fifty-nine patients with adrenal adenoma-type SCS un-derwent laparoscopic unilateral adrenalectomy.Adrenal insufficiency was assessed one month postoperatively based on se-rum cortisol levels.Preoperative general data[gender,age,body mass index(BMI),blood pressure,metabolic comorbid-ities(overweight/obesity,hypertension,abnormal glucose metabolism,dyslipidemia,osteopenia/osteoporosis),tumor di-ameter],preoperative adrenal function-related hormone levels[adrenocorticotropic hormone(ACTH)and cortisol diurnal rhythm(8:00,24:00),cortisol after 1 mg dexamethasone suppression test(1 mg-DST),cortisol after low-dose dexameth-asone suppression test(LDDST),serum dehydroepiandrosterone sulfate(DHEAS),and 24-hour urine free cortisol(UFC)],and postoperative glucocorticoid use were compared between patients with adrenal insufficiency and those with normal adrenal function.We constructed a binary Logistic regression analysis model using indicators with intergroup com-parison of P<0.10,analyzed the influencing factors of postoperative adrenal insufficiency in patients with SCS,and evalu-ated the predictive efficacy of relevant indicators by the receiver operating characteristic(ROC)curve.Results Adrenal insufficiency was observed in 25 out of 59 patients with SCS one month after surgery,accounting for 42.37%of these cas-es.Compared with patients with normal adrenal function,patients with adrenal insufficiency had decreased plasma ACTH levels at 8:00,and increased serum cortisol levels at 24:00 and after 1 mg-DST before surgery.Logistic regression analy-sis showed that preoperative serum cortisol after 1 mg-DST was an independent influencing factor for the development of ad-renal insufficiency in patients with SCS postoperatively.The relative risk ratio of adrenal insufficiency after surgery in SCS patients with preoperative 1 mg-DST serum cortisol≥233 nmol/L was 13.698(95%CI:2.965-63.274).Conclusions Patients with SCS are at risk of developing adrenal insufficiency after surgery.Preoperative serum cortisol after 1 mg-DST is an independent influencing factor for postoperative adrenal insufficiency and has good predictive efficacy on the occur-rence of adrenal insufficiency after surgery.
adrenal adenomasubclinical Cushing's syndromecomplications after adrenalectomyadrenal insuf-ficiency
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