Cosyntropin stimulation testing on postoperative day 1 allows for selective glucocorticoid replacement therapy after adrenalectomy for XXXX : Results of a novel, multidisciplinary institutional protocol.

@entity1 @entity773 @entity1887 @entity699 @entity701 @entity1368 @entity4304
BACKGROUND: @entity1887 (AI) can occur after unilateral adrenalectomy for adrenal-dependent @entity699 . Postoperative glucocorticoid replacement (GR), although given routinely, may not be necessary. We sought to identify factors that, in combination with postoperative day 1 cosyntropin stimulation testing ( @entity773 -CST), would predict the need for GR. METHODS: We reviewed 31 consecutive @entity1 who underwent unilateral adrenalectomy for @entity699 (study @entity1 ) or @entity1368 (control @entity1 ). A standard @entity773 -CST protocol was used. @entity701 was started for clinical evidence of AI, basal plasma @entity701  <=5 ( g/dL), or a stimulated plasma @entity701 <18. RESULTS: A normal @entity773 -CST was found in all nine control @entity1 and 11 of 22 @entity1 (50%) with @entity699 ; the other 11 study @entity1 (50%) received GR based on the @entity773 -CST. These @entity1 were younger (51 vs 62  years; P  =  .017), had a higher body mass index (BMI; 31 vs 29  kg/m(2)), and smaller @entity4304 (16.9 vs 33.0  g; P  =  .009) than non-GR study @entity1 . CONCLUSION: After unilateral adrenalectomy for @entity699 , only 50% of @entity1 received GR. No preoperative biochemical characteristics were associated with postoperative AI, although @entity1 who received GR were younger, and tended to have a higher BMI and smaller adrenal nodules. Use of this novel protocol for postoperative dynamic adrenal function testing prevented unnecessary GR in 50% of @entity1 and allowed for individualized @entity1 care.
