The clinical study of glucocorticoid replacement therapy after unilateral adrenal adenomaresection by retroperitoneal laparoscopy

Objective: To investigate the need for glucocorticoid replacement (GR) therapy after retroperitoneal laparoscopic resection of unilateral adrenal cortical adenoma. Methods: This study included patients with unilateral adrenal adenoma after surgery, and the postoperative pathological results were adrenal cortical adenomas. 35 patients were evaluated, 12 males and 23 females. All patients underwent retroperitoneal laparoscopy successfully. Adrenal adenoma resection was divided into two groups according to whether hormone replacement therapy was used after surgery. One group was 28 patients who did not use hormone replacement after surgery (no hormone replacement group); the other group was 7 patients who received hormone replacement after surgery (hormone replacement group). Routine preoperative tests and adrenal related tests, basal serum cortisol, plasma adrenocorticotropic hormone (ACTH), percentage of eosinophils and the number of eosinophils were determined in the morning within 3 days after surgery. Results: Before surgery, the two groups were no statistical difference (P>0.05)in gender, age, left and right sides of the tumor, maximum tumor diameter, hypertension, diabetes, heart rate, eosinophil percentage, eosinophil count, serum potassium, serum sodium, cortisol 8:00am,4:00pm,24:00pm, ACTH, renin-angiotensin II-aldosterone (recumbent/standing position). After surgery, the two groups had differences in the morning basal serum cortisol (cortisol 8:00am) and ACTH(F=25.037, P<0.001; F=12.033, P=0.001), while eosinophils were no difference in percentage and number of eosinophils between the two groups. Conclusion: After laparoscopic adrenal adenoma resection, the level of cortisol is low on the first postoperative day, but most of the adrenal cortisol responds well to ACTH stimulation. Cortisol on the second and third days after surgery is basically normal without hormone replacement. However, for the continuous low levels of cortisol and ACTH 3 days after surgery, supplemental hormones should be actively given in the early stage. Therefore, after unilateral adrenalectomy, continuously review the levels of cortisol and ACTH, and use glucocorticoid replacement therapy if necessary.