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The Incidence of Long-Term Adrenal Insufficiency Following Unilateral Adrenalectomy is Low: Case Series and Review of Literature

Introduction: Acquired adrenal insufficiency is a known risk of unilateral adrenalectomy. However, the 
rates of early and prolonged adrenal insufficiency following unilateral adrenalectomy are not well defined 
in the literature. 
Patients and Methods: We reviewed a case series of 184 consecutive patients to determine the likelihood 
of steroid supplementation at 30 days and 1 year following adrenalectomy. 109 lesions were non-functional 
and 75 (41%) demonstrated functionality, including 33 pheochromocytomas, 20 cortisol-producing 
adenomas, 19 aldosteronomas, and 3 cases of cortisol-secreting hyperplasia. No patients with a nonfunctional lesion, pheochromocytoma, or aldosteronoma required steroid supplementation following 
surgery. Eleven of 23 patients (48%) with primary adrenal Cushing syndrome required cortisol 
supplementation at 30 days, and only 1 patient (4%) necessitated supplementation one year following 
surgery. 
Discussion: Approximately 50% of patients with cortisol-producing lesions in the adrenal gland will require 
supplementation 30-days following surgery. Only 4% will require persistent exogenous steroids at 1-year. 
Conversely, less than 1% of patients with different types of functional or non-functional tumors required 
supplementation after surgery. 
Conclusion: The incidence of adrenal insufficiency following unilateral adrenalectomy is low. A large 
majority of patients requiring steroid supplementation 30 days following surgery are able to wean off this 
requirement by 1 year. With this information, we can better counsel our patients and set clearer expectations 
for the potential need of cortisol supplementation following adrenalectomy