ASO Author Reflections: Continued Refinement of Perioperative Protocols to Predict Secondary Adrenal Insufficiency After Unilateral Adrenalectomy

Adrenalectomy is the most definitive treatment for patients with functional adrenal adenomas, especially those with adrenocorticotropic hormone (ACTH)-independent hypercortisolism.¹ Secondary adrenal insufficiency (SAI) has long been known to be a possible consequence of unilateral adrenalectomy. Symptoms can include refractory hypotension and electrolyte imbalances and can be life-threatening; thus, glucocorticoid replacement has historically been prescribed liberally during the postoperative period. Prophylactic glucocorticoid dosing at the time of surgery and routine glucocorticoid replacement postoperatively for all patients undergoing unilateral adrenalectomy for hypercortisolism has long been a standard practice. More recently, growing recognition of the potential harm of glucocorticoid use has led to institutional protocols to tailor glucocorticoid replacement to patients only with biochemical or and/or clinical evidence of postoperative SAI. …