title: Adrenal reserve function after unilateral adrenalectomy in patients with primary aldosteronism.
abstract: OBJECTIVE
  After unilateral adrenalectomy (uADX) in patients with a unilateral aldosterone-producing adenoma (APA), the remaining contralateral adrenal gland is generally considered sufficient to support life. However, few studies have compared adrenal reserve function before and after uADX. Therefore, we closely evaluated adrenal cortisol secretory function before and after uADX in patients with unilateral APA.
  
  
  METHODS
  Patients who were diagnosed with APA and underwent uADX for unilateral APA were initially included in this study. Patients with subclinical Cushing's syndrome (SCS) or Cushing's syndrome were excluded on suspicion of autonomous cortisol secretion. Fourteen patients were finally evaluated. Morning basal serum cortisol and plasma adrenocorticotropin hormone (ACTH) levels were measured, and ACTH stimulation tests under 1-mg dexamethasone suppression (dex-ACTH test) were performed before and after uADX.
  
  
  RESULTS
  No patient developed clinical adrenal insufficiency. Basal cortisol levels were not significantly different before and after uADX. However, basal ACTH levels were significantly elevated after uADX. In addition, peak cortisol levels on the dex-ACTH test decreased in all patients after uADX. The peak cortisol level after uADX was 86.6 (81.4-92.4)% of the level before uADX.
  
  
  CONCLUSIONS
  The adrenal cortisol secretory response to ACTH stimulation is mildly reduced after uADX in patients with unilateral APA without SCS or Cushing's syndrome, although their basal cortisol level is sustained by elevated ACTH. These data will be important as a point of discussion when patients with unilateral APA consider either uADX or specific pharmacotherapy as treatment options.
authors.affiliation: aDepartment of Medicine and Clinical Science, Kyoto University Graduate School of Medicine bDepartment of Clinical Trial Design & Management, Translational Research Center, Kyoto University Hospital cEBM Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Honda
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Sone
authors.forename: Naohisa
authors.initials: N
authors.lastname: Tamura
authors.forename: Takuhiro
authors.initials: T
authors.lastname: Sonoyama
authors.forename: Daisuke
authors.initials: D
authors.lastname: Taura
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Kojima
authors.forename: Yorihide
authors.initials: Y
authors.lastname: Fukuda
authors.forename: Shiro
authors.initials: S
authors.lastname: Tanaka
authors.forename: Shinji
authors.initials: S
authors.lastname: Yasuno
authors.forename: Toshihito
authors.initials: T
authors.lastname: Fujii
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kinoshita
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ariyasu
authors.forename: Naotetsu
authors.initials: N
authors.lastname: Kanamoto
authors.forename: Masako
authors.initials: M
authors.lastname: Miura
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yasoda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Arai
authors.forename: Kenji
authors.initials: K
authors.lastname: Ueshima
authors.forename: Kazuwa
authors.initials: K
authors.lastname: Nakao
mesh_terms: D000236:Adenoma / Q000097:blood* / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000097:blood* / Q000601:surgery*; D000311:Adrenal Glands / Q000378:metabolism*; D000315:Adrenalectomy; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D019540:Area Under Curve; D001794:Blood Pressure; D003480:Cushing Syndrome / Q000150:complications; D003907:Dexamethasone / Q000737:chemistry; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000737:chemistry; D006929:Hyperaldosteronism / Q000097:blood / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D013997:Time Factors
chemical_list: D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone