Work

The utility of cosyntropin stimulation test in the assessment of adrenal function after unilateral adrenalectomy

Year: 2026

Type: article

Abstract: BACKGROUND: There are scant data in the literature regarding assessment of adrenal function after unilateral adrenalectomy. Most research has involved patients with mild autonomous cortisol secretion, with recommendations to use the cosyntropin stimulation test and basal cortisol to diagnose secondary adrenal insufficiency. Our aim was to investigate the utility of the cosyntropin stimulation test in the assessment of adrenal function after unilateral adrenalectomy. METHODS: This was a retrospective institutional review board-approved study of patients who underwent unilateral adrenalectomy between 2010 and 2025, followed by basal morning cortisol and a cosyntropin stimulation test on postoperative day 1. The relationship between postoperative day 1 cortisol and the cosyntropin stimulation test was investigated. RESULTS: There were 179 patients with mild autonomous cortisol secretion and 119 with non-cortisol-secreting tumors. The cosyntropin stimulation test was normal when postoperative day 1 cortisol was >10 μg/dL in both groups. When postoperative day 1 cortisol was less than 5 mg/dL, the cosyntropin stimulation test was abnormal in 75% of patients in the mild autonomous cortisol secretion group and in 27% in the non-cortisol-secreting tumor group. When postoperative day 1 cortisol was 5-10 mg/dL, the cosyntropin stimulation test was abnormal in 38% of patients in the mild autonomous cortisol secretion group and 12% in the non-cortisol-secreting tumor group. CONCLUSION: Routine postoperative day 1 morning cortisol followed by a selective cosyntropin stimulation test may enable a patient-custom assessment of adrenal insufficiency and minimize unnecessary steroid replacement after unilateral adrenalectomy. The most practical use of the cosyntropin stimulation test seems to be in patients with postoperative day 1 cortisol levels between 5 and 10 mg/dL.

Source: Surgery

DOI: 10.1016/j.surg.2026.110585