Imperial College London
Alternate

Professor Amir H Sam

Faculty of Medicine, Faculty of Medicine Centre

Head of Imperial College School of Medicine, Professor
 
 
 
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Contact

 

a.sam

 
 
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Location

 

148Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

Citation

BibTex format

@article{Zaman:2021:10.3389/fendo.2021.654600,
author = {Zaman, S and Almazrouei, R and Sam, AH and DiMarco, AN and Todd, JF and Palazzo, FF and Tan, T and Dhillo, WS and Meeran, K and Wernig, F},
doi = {10.3389/fendo.2021.654600},
journal = {Frontiers in Endocrinology},
pages = {1--7},
title = {Synacthen stimulation test following unilateral adrenalectomy needs to be interpreted with caution},
url = {http://dx.doi.org/10.3389/fendo.2021.654600},
volume = {12},
year = {2021}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Background: Cortisol levels in response to stress are highly variable. Baseline and stimulated cortisol levels are commonly used to determine adrenal function following unilateral adrenalectomy. We report the results of synacthen stimulation testing following unilateral adrenalectomy in a tertiary referral center.Methods: Data were collected retrospectively for 36 patients who underwent synacthen stimulation testing one day post unilateral adrenalectomy. None of the patients had clinical signs of hypercortisolism preoperatively. No patient received pre- or intraoperative steroids. Patients with overt Cushing’s syndrome were excluded.Results: The median age was 58 (31-79) years. Preoperatively, 16 (44%) patients had a diagnosis of pheochromocytoma, 12 (33%) patients had primary aldosteronism and 8 (22%) patients had non-functioning adenomas with indeterminate/atypical imaging characteristics necessitating surgery. Preoperative overnight dexamethasone suppression test results revealed that 6 of 29 patients failed to suppress cortisol to <50 nmol/L. Twenty (56%) patients achieved a stimulated cortisol ≥450 nmol/L at 30 minutes and 28 (78%) at 60 minutes. None of the patients developed clinical adrenal insufficiency necessitating steroid replacement.Conclusions: Synacthen stimulation testing following unilateral adrenalectomy using standard stimulated cortisol cut-off values would wrongly label many patients adrenally insufficient and may lead to inappropriate prescriptions of steroids to patients who do not need them.
AU  - Zaman,S
AU  - Almazrouei,R
AU  - Sam,AH
AU  - DiMarco,AN
AU  - Todd,JF
AU  - Palazzo,FF
AU  - Tan,T
AU  - Dhillo,WS
AU  - Meeran,K
AU  - Wernig,F
DO  - 10.3389/fendo.2021.654600
EP  - 7
PY  - 2021///
SN  - 1664-2392
SP  - 1
TI  - Synacthen stimulation test following unilateral adrenalectomy needs to be interpreted with caution
T2  - Frontiers in Endocrinology
UR  - http://dx.doi.org/10.3389/fendo.2021.654600
UR  - https://www.frontiersin.org/articles/10.3389/fendo.2021.654600/full
UR  - http://hdl.handle.net/10044/1/89121
VL  - 12
ER  -
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