Unrecognized Adrenal Insufficiency in Patients Undergoing Laparoscopic Adrenalectomy

Introduction: There is scant data in the literature about unrecognized adrenal insufficiency (AI) in patients undergoing laparoscopic adrenalectomy (LapA). We hypothesized that postoperative day (POD) 1 AM cortisol levels could identify these patients after LapA. The aim of his study is to determine the incidence of AI after LapA and identify clinical predictors. Methods: One hundred and three patients underwent LapA at the Cleveland Clinic between June 2000 and August 2007. Patients with Cushing’s syndrome, bilateral disease or conditions associated with bilateral disease were excluded leaving 71 patients for the analysis. All patients had preoperative serum and 24-hour urine cortisol analyses performed. AM cortisol levels were drawn on POD 1 in 40 patients (16 nonfunctional adenomas, 13 pheochromocytomas, 3 aldosteronomas, 2 testosterone secreting adenomas, 3 other benign lesions, 2 metastasis and 1 adrenocortical cancer). None of these patients received preoperative steroids. Data were analyzed using one-way ANOVA, t-test and Chi-square. Results: The mean POD 1 AM cortisol levels were 11.9±1.8 ug/dL for pheochromocytomas, 10.3±1.6 ug/dL for nonfunctional adenoma, 6.9±3.2 ug/dL for aldosteronoma, 6.9±6.9 ug/dL for malignant tumors, and 4.1±3.6 ug/dL for other benign lesions. There were 3 groups of patients identified based on POD 1 AM cortisol levels: sufficient (>10ug/dL; n=21), low normal (3.4 – 10ug/dL; n=9) and insufficient (


Session: Podium Presentation

Program Number: S057

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