PMC6398404_01
Imaging of adrenal glands.. Notes: The arrows indicate the nodule in the right (yellow) and left (red) adrenal gland. (A) Image of CT. (B) Merged image of CT and 131-I adosterol SPECT. (C) Image of 131-I adosterol SPECT.. Abbreviations: CT, computed tomography; SPECT, single photon emission computed tomography.
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Maximum nodule size in the left-side gland was 34 mm with strong uptake, and 31 mm with relatively weak uptake in the right-side gland (Figure 1).
Aberrant responses of cortisol secretion preoperatively.. Notes: Vertical axis indicates serum cortisol level. Horizontal axis indicates time course after exogenous stimuli.. Abbreviations: ACTH, adrenocorticotropic hormone; GnRH, gonadotropin-releasing hormone.
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Results are shown in Figure 2.
Cortisol secretion on metoclopramide challenge at postoperative day 8.. Notes: Vertical axis indicates serum cortisol level. Horizontal axis indicates time course after metoclopramide administration. Numerical values are also shown with trajectory.
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A baseline morning cortisol level of 2.96 microg/dL strongly suggested adrenal insufficiency, but the peak level following administration of metoclopramide was at 19.7 microg/dL (representing an increase of 666%, Figure 3).On receiving hydrocortisone 15 mg/day, the patient showed no signs of adrenal insufficiency thereafter, and was therefore uneventfully discharged at postoperative day 10.
Time course of morning serum cortisol before and after left adrenalectomy.. Notes: Vertical axis indicates morning serum cortisol level. Horizontal axis indicates time course before and after left adrenalectomy (week 0). Three data points collected before surgery, and data collected at postoperative days 8, 72 and 109 are shown. Regimen of steroid coverage at day 8 was hydrocortisone 15 mg/day (10 and 5 mg after breakfast and dinner, respectively). Regimen of steroid coverage at days 72 and 109 was hydrocortisone 12.5 mg/day, 10 and 2.5 mg after breakfast and dinner, respectively. Numerical values are also shown with trajectory.
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Markedly decreased morning serum cortisol levels were repeatedly confirmed, and adrenal insufficiency was strongly suggested even at day 109; thus, steroid coverage could not be withdrawn (Figure 4).