Primary
aldosteronism (PA) is the most frequent form of endocrine
hypertension. Recently, frequent clinically significant
adrenal insufficiency after
adrenalectomy in subjects with PA has been reported, which may make the early postsurgical management difficult. We retrospectively searched for possible
adrenal insufficiency in subjects who underwent
adrenalectomy for PA and have measured
cortisol in the early postoperative course. We included subjects with confirmed diagnosis of PA who underwent either posture testing (blood draw at 06:00 and 08:00) and/or adrenal venous sampling (AVS) (blood draw between 08:00 and 09:00) and have also measured
cortisol after surgery (
cortisol measured approximately at 07:00).
Cortisol was measured by immunoassay. In this study, we identified 150 subjects (age 48.5 ± 10.3 years) with available
cortisol values in the early postoperative course (median [25th percentile, 75th percentile]) 6 [5,6] days. Postoperative
cortisol values (551 ± 148 nmol/l) were normal and significantly higher, compared to preoperative standing
cortisol values (404 ± 150 nmol/l; (P < 0.001) and AVS
cortisol values (493 ± 198 nmol/l; P = 0.009), and did not significantly differ from preoperative supine
cortisol values. Postsurgical
cortisol values were not different among subjects with or without abnormal
dexamethasone suppression test or elevated urinary free
cortisol pre-surgery, and were significantly higher in subjects with abnormal diurnal
cortisol variability compared with subjects with normal diurnal variability. No patient presented with adrenocortical crisis in the later follow-up. In conclusion, postoperative
cortisol values did not indicate any suspicion of possible
adrenal insufficiency. To exclude possible
adrenal insufficiency, it may be sufficient to measure morning
cortisol in the early postoperative course.