title: Critical size of residual adrenal tissue and recovery from impaired early postoperative adrenocortical function after subtotal bilateral adrenalectomy.
abstract: BACKGROUND
  Subtotal bilateral adrenalectomy may preserve adrenocortical function. Little is known about the early postoperative function of the adrenal remnant.
  
  
  METHODS
  In 10 patients with bilateral adrenal tumors (pheochromocytomas, adrenocortical nodular hyperplasia, and adrenal metastases), plasma adrenocorticotropic hormone (ACTH), serum cortisol, and maximal cortisol liberation were examined with an ACTH test after subtotal bilateral adrenalectomy, which left 15% to 30% of adrenal tissue in situ.
  
  
  RESULTS
  In the early postoperative period, all patients had normal basal serum cortisol levels (mean, 415+/-208 nmol/L; normal morning range, 138-690 nmol/L) but pathologically increased plasma ACTH levels (mean, 55+/-42 pmol/mL; normal, <10.1 pmol/L). In 6 patients, a pathologic ACTH test result was observed. During follow-up (mean, 11.3+/-7.6 months), all patients were found to have a normal ACTH test result. None of the patients required steroid supplementation. However, in patients with both familial pheochromocytoma and impaired adrenocortical function during the early postoperative period, the maximal increase of serum cortisol after ACTH stimulation was significantly reduced (mean, 301+/-86.8 nmol/L) compared with control subjects (mean, 490+/-132.6 nmol/L; P=.019).
  
  
  CONCLUSIONS
  After subtotal bilateral adrenalectomy left 15% to 30% of adrenal tissue in situ, functional recovery could be observed in all patients. However, subclinical impairment of the adrenocortical function with questionable clinical significance has to be considered in some of the patients. Especially during the early postoperative period, careful observation of the patients without exogenous steroid administration is required.
authors.affiliation: Department of General, Visceral, and Vascular Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06097 Halle/Saale, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Brauckhoff
authors.forename: Oliver
authors.initials: O
authors.lastname: Gimm
authors.forename: Phuong Nguyen
authors.initials: PN
authors.lastname: Thanh
authors.forename: Annett
authors.initials: A
authors.lastname: Bär
authors.forename: Jörg
authors.initials: J
authors.lastname: Ukkat
authors.forename: Katrin
authors.initials: K
authors.lastname: Brauckhoff
authors.forename: Thomas
authors.initials: T
authors.lastname: Bönsch
authors.forename: Henning
authors.initials: H
authors.lastname: Dralle
mesh_terms: D000304:Adrenal Cortex Function Tests / Q000379:methods; D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000311:Adrenal Glands / Q000503:physiopathology*; D000315:Adrenalectomy / Q000379:methods*; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D001837:Body Weights and Measures; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function / Q000502:physiology
chemical_list: D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone