Cortisol Testing to Diagnose Adrenal Insufficiency Following Adrenalectomy for Mild Autonomous Cortisol Secretion
Authors' conclusion
Approximately half of patients with MACS developed postoperative adrenal insufficiency, with 50% recovering by 3.9 months after surgery. BSS correlated with basal cortisol, CST, and duration of adrenal insufficiency. As discordant results were noted in 22%, performing both basal cortisol and CST postoperatively should be considered.
Study context
- Population
- Patients with mild autonomous cortisol secretion (MACS) undergoing unilateral adrenalectomy (80% women)
- Participants
- 281 patients
- Outcome
- Prevalence of postoperative adrenal insufficiency (basal cortisol <10 µg/dL and/or CST <18 µg/dL)
Methodological detailsmulticenter
- Multicenter
Main finding
As reported in the abstract
Postoperative adrenal insufficiency
Postoperative adrenal insufficiency
153
54.5%
Observational data: associations, not effects.
Further findings
Predictors of adrenal insufficiency: age
- Adrenal insufficiency inversely correlated with age, OR per 10 years
- 0.67 (95% CI, 0.53-0.84)
- Low basal cortisol and CST associated with younger age, OR per 10 years for both
- 0.64
- Low basal cortisol associated with higher BSS, OR
- 1.17
- Low CST associated with higher BSS, OR
- 1.22
Discordance between basal cortisol and CST
- Discordant results
- 22%
- Discordance, bilateral nodules vs others
- 32% vs 19%; P < .001
Time to adrenal insufficiency recovery
- Median time to recovery
- 3.9 months (IQR, 3-5.9 months)
- Mild BSS and clinical severity scores (CSS)
- 3 months
- Moderate BSS and CSS
- 4 to 5 months
- Severe BSS and CSS
- 12 to 14 months
- Longer duration associated with higher BSS and CSS
Original publication
Cortisol Testing to Diagnose Adrenal Insufficiency Following Adrenalectomy for Mild Autonomous Cortisol Secretion. J Clin Endocrinol Metab. Published 12 September 2025. doi:10.
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