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Horm Metab Res 2022; 54(06): 354-360
DOI: 10.1055/a-1850-2169
Original Article: Endocrine Care

The Relationship Between Baseline Cortisol Levels and Surgery Method of Primary Bilateral Macronodular Adrenal Hyperplasia

Jie Gao
1   Department of Endocrinology, Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
,
Zhongwei Yu
2   Department of Urology, Ruijin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
,
Fukang Sun
3   Department of Urology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
,
Bilin Xu
4   Department of Endocrinology, Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
,
Cuiping Zhang
4   Department of Endocrinology, Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
,
Hongping Wang
4   Department of Endocrinology, Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
,
Jun Lu
4   Department of Endocrinology, Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
,
Tao Lei
4   Department of Endocrinology, Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Abstract

Aim was to explore the associations between baseline cortisol levels and surgery method of primary bilateral macronodular adrenal hyperplasia (PBMAH). We retrospectively reviewed the clinical features and management of 30 patients (18 females and 12 males) who were diagnosed with PBMAH in our center between 2005 and 2019. Based on surgery method, we divided the patients into two groups: unilateral adrenalectomy (UA) group; and bilateral adrenalectomy (BA) group. Serum cortisol rhythm and 24-hour urinary free cortisol (UFC/24 h) levels were assayed using chemiluminescence method. Associations between baseline cortisol levels and BA were assessed using logistic regression. The predictive value of baseline cortisol levels for BA was calculated using receiver operating characteristic (ROC) curves. Twenty patients (66.7%) underwent UAs and ten patients (33.3%) underwent BAs. After adjusting for age, sex, BMI, SBP, and adrenal volume, the concentrations of baseline serum cortisol (8 AM, 4 PM, and 0 AM) and UFC/24 h were associated with bilateral adrenalectomy (all p<0.05). The area under the ROC curve based on 8 AM serum cortisol level model was larger than that in models based on 4 PM, 0 AM serum cortisol levels and UFC/24 h, but the differences were non-significant (all p>0.05). According to maximum Youden index criteria, the optimal cutoffs of 8 AM serum cortisol level and UFC were 26.89 μg/dl and 406.65 μg/24 h, respectively, for BA. The baseline cortisol levels are positively associated with BA. Increased levels of baseline cortisol levels may predict higher possibility of BA, which should be confirmed by prospective studies.

Key words

serum cortisol - 24-hour urinary free cortisol - surgery method - primary bilateral macronodular adrenal hyperplasia


Publication History

Received: 25 January 2022

Accepted after revision: 03 May 2022

Article published online:
13 June 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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