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Adrenal (Excluding Mineralocorticoids)

ORF25-01 - Prevalence and Duration of Adrenal Insufficiency after Unilateral Adrenalectomy for Autonomous Cortisol Secretion: A Prospective Cohort Study

Sunday, June 14, 2026
9:30 AM - 9:35 AM CT
Location: Room W183BC

Context: Evidence on the prevalence and duration of adrenal insufficiency (AI) after unilateral adrenalectomy (ULA) in autonomous cortisol secretion (ACS) is scarce.

Objective: To determine the prevalence and duration of AI after ULA in ACS and factors influencing the same.

Methods: We conducted a single center prospective cohort study, 2019-2025, of patients with ACS after ULA. AI was defined as glucocorticoid (GC) initiation and a postoperative day 1 serum cortisol < 10 µg/dL or a post-cosyntropin stimulation test cortisol < 18 µg/dL. For patients empirically started on GC therapy, a morning cortisol < 10 µg/dL within 6 months postoperatively confirmed AI. Duration of AI was considered till GC discontinuation. Associations of demographics, disease laterality (unilateral vs. bilateral adrenal nodularity/hyperplasia on imaging, regardless of functional laterality) and clinical/biochemical hypercortisolism severity with AI and its duration were evaluated.

Results: 277 patients [65% unilateral, 35% bilateral, median age at diagnosis 58 years (IQR: 48-66), 77% women] underwent ULA. Postoperative AI occurred in 100/179 (56%) patients with unilateral and 43/98 (44%) with bilateral disease (P=0.057). In multivariable analysis of age, sex, body mass index (BMI), clinical severity score, laterality, and ACTH, younger age at diagnosis [OR=0.97 (95% CI:0.94-0.99), P=0.005], lower baseline ACTH [OR 0.95 (95% CI:0.92-0.99), P=0.009], higher clinical severity score [OR 1.08 (95% CI:1.02-1.15), P=0.007], and unilateral disease [OR 2.01 (95% CI:1.15-3.55), P=0.015] were associated with higher risk of AI. Higher biochemical severity score was associated with AI in univariable [OR 1.26 (95% CI:1.09-1.47), P=0.003] and multivariable analysis adjusted for age, sex, BMI and laterality [OR 1.26 (95% CI:1.07-1.49), P=0.006]. The median duration of AI was longer in unilateral than bilateral disease [6 months (IQR 2-14) vs. 4 months (IQR 2-7), P=0.031]. In multivariable analysis of age, sex, BMI, clinical severity score, GC type, and laterality, slower AI recovery was seen in those with higher clinical severity score [HR 0.93 (95% CI: 0.89-0.97), P< 0.001] and unilateral disease [HR 0.54 (95% CI: 0.33-0.88), P=0.015]. Higher biochemical severity score was associated with slower recovery of AI in both univariable [HR 0.73 (95% CI: 0.65-0.82), P< 0.001] and multivariable analysis adjusted for age, sex, BMI, GC type and laterality [HR 0.72 (95% CI: 0.64-0.82), P< 0.001]. Duration of AI was not impacted by GC type (prednisone vs. hydrocortisone) in either univariable and multivariable analyses.

Conclusion: Higher biochemical and clinical severity scores and unilateral disease were associated with higher prevalence and duration of postoperative AI, indicating that an individualized approach to glucocorticoid therapy is needed to prevent over- and under-treatment.