Adrenal insufficiency after operative removal of apparently nonfunctioning adrenal adenomas
C. M. Huiras, G. B. Pehling and R. H. Caplan
Department of Surgery, Gundersen Clinic Ltd., La Crosse, WI.
We describe a woman who developed adrenal insufficiency after removal of an
apparently nonfunctional adrenal adenoma. She displayed no stigmata of
Cushing's syndrome and had normal plasma and urinary cortisol levels. A
second patient without clinical findings of Cushing's syndrome also had
normal basal steroid levels. This patient displayed partial suppressibility
with dexamethasone, had low-normal levels of serum corticotropin, and
excreted a low concentration of urinary 17-ketosteroids. She also developed
mild adrenal insufficiency after the operation. We believe the adrenal
adenomas in these patients secreted enough cortisol to suppress the
contralateral adrenal gland but not enough hormone to elevate basal steroid
levels. Therefore, we suggest that all patients with adrenal masses be
studied with the overnight dexamethasone suppression test rather than basal
steroid hormone measurements to detect low levels of autonomous cortisol
secretion. In addition, patients with adrenal masses that are not removed
surgically should have serial adrenal function tests performed.
