Glucocorticoid replacement duration after unilateral adrenalectomy for mild autonomous cortisol secretion and adrenal Cushing syndrome: a multicenter cohort study
Authors' conclusion
Older age was consistently associated with delayed recovery, while biochemical markers contributed differentially by disease subtypes.
Study context
- Population
- Adults with mild autonomous cortisol secretion (MACS) or adrenal Cushing syndrome (CS) who underwent unilateral adrenalectomy and required postoperative glucocorticoid replacement
- Participants
- 139 vs 280
- Exposure
- MACS vs adrenal CS
- MACSn = 139
- Adrenal CSn = 280
- Outcome
- Time to hypothalamic-pituitary-adrenal axis (HPAA) recovery, defined as discontinuation of glucocorticoids
Methodological detailsmulticenter
- Multicenter
Main finding
As reported in the abstract
Time to HPAA recovery (Kaplan-Meier)
Observational data: associations, not effects.
Further findings
Factors associated with recovery in MACS (Cox HR; Restricted mean survival time (RMST), τ = 540 days)
- Older age, delayed recovery: HR per 10 years
- 0.72
- Age >61 years, delayed recovery
- +94 days
- Post-ODST cortisol > 10.0 µg/dL, delayed recovery
- +113 days
- Higher DHEAS ratio, faster recovery: HR per log-unit
- 1.50
- DHEAS ratio >0.61, faster recovery
- −91 days
- Higher adrenocorticotropic hormone (ACTH), faster recovery: HR per log-unit
- 1.61
Factors associated with recovery in adrenal CS (Cox HR; RMST, τ = 1095 days)
- Older age, delayed recovery: HR per 10 years
- 0.74
- Age >36 years, delayed recovery
- +198 days
- Higher HbA1c, delayed recovery: HR per 1%
- 0.81
- Post-ODST cortisol >7.9 µg/dL, delayed recovery
- +364 days
- Higher ACTH, faster recovery: HR per log-unit
- 1.27
- ACTH >5.1 pg/mL, faster recovery
- −130 days
Original publication
Glucocorticoid replacement duration after unilateral adrenalectomy for mild autonomous cortisol secretion and adrenal Cushing syndrome: a multicenter cohort study. Eur J Endocrinol. Published 3 September 2026. doi:10.
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