Dynamic Changes In Plasma Cortisal Post-adrenalectomy

Background and objective:Cushing syndrome patients in peri operation period of routine to supplement the adrenal cortex hormone to prevent adrenal insufficiency or adrenal crisis, but it may also occur in adrenal insufficiency of hypercortisolism with adrenal tumor patients or patients after other operations. There are few reports on the changes of adrenal hormone secretion in patients with adrenal tumor. This experiment is to prospective investigate the changes in cortisol hormone level in plasma during peri operation in patients with adrenal tumor, understand the incidence of adrenal insufficiency after operation, and in order to provide a guide for peri operation period of hormone use.Method.Selection of55cases of adrenal tumors patients with surgical operation during2012December to2014May, taking peripheral blood for determination of plasma cortisol levels in the first,3th,5th days after operation and preoperative in the morning at8:00o’clock while supine resting. Study of adrenal cortical hormone changes after operation, and the effection of different diseases (hypercortisolism and non hypercortisolism), different surgery method (partial adrenalectomy and adrenalectomy), different age groups (<50years and≥50years) and different tumor size (≥3cm and<3cm) on postoperative cortisol secretion. Result.1. All of the55patients first days after operation, plasma cortisol levels decreased significantly (mean283.46nmol/L*),(*means cortisol levels compared with preoperative has statistical significance). The third days increased (mean337.47nmol/L), but was still lower than that before treatment, with statistical significance compared with the preoperative. To5th days after operation recovered to the preoperative level (mean408.26nmol/L), and contrast with preoperative has no statistical significance.2. In hypercortisolism with non hypercortisolism with grouping comparison, Cushing syndrome group after first days of plasma cortisol levels decreased significantly (mean227.4nmol/L*); after third days increased (mean291.7nmol/L*), but still relatively low preoperative to postoperative fifth days; not returned to the preoperative level (the mean value of429.5nmol/L). Instead of hypercortisolism group after first days of plasma cortisol levels decreased significantly (mean272.96nmol/L*); after third days increased (mean343.08nmol/L*); after fifth days and returned to the preoperative level (mean405.66nmol/L). Differences between two groups of patients with plasma cortisol changes after operation was not statistically significant. Cortisol increased after operation in patients with adrenal cortical hypofunction of the incidence was higher than that of non hypercortisolism.3. After unilateral partial adrenalectomy and unilateral adrenalectomy two contrast, days of plasma cortisol levels of partial adrenalectomy group after first decreased significantly (mean284.41nmol/L*); third days after operation (average350.23nmol/L), rising to fifth days after operation; has recovered to the preoperative level (mean377.08nmol/L). While the total adrenalectomy group after first days of plasma cortisol levels decreased significantly (mean265.06nmol/L*); third days after operation (average338.14nmol/L); up to fifth days after operation recovered to the preoperative level (mean425.37nmol/L). Differences between two groups of patients with plasma cortisol changes after operation was not statistically significant. Far and adrenalectomy patients incidence of cortical dysfunction of kidney resection after similar.4. In the<50age group and≥50years old group, two group of comparison, the<50age group after first days of plasma cortisol levels decreased significantly (mean248.38nmol/L*); after third days increased (mean321.43nmol/L); at the day fifth after transplantation has recovered to the preoperative level (mean413.54nmol/L), and preoperative contrast not significant. And cortisol levels of plasma≥50years old group after first decreased (mean315.30nmol/L); third days after operation (average380.35nmol/L); up to fifth days after operation recovered to the preoperative level (mean392.09nmol/L). Differences between two groups of patients with plasma cortisol changes after operation was not statistically significant. The age group of<50patients after cortical hypofunction occurred more than50years of age or older group.5.<3cm in diameter and diameter of adrenal tumor>3cm adrenal tumors between two groups, the diameter of<3cm adrenal tumor group after first days of plasma cortisol levels decreased significantly (mean251.1nmol/L*); after third days increased (mean345.1nmol/L); at the day fifth after transplantation has recovered to the preoperative level (mean447.3nmol/L). And cortisol levels of plasma diameter≥3cm group after first decreased significantly (mean295.7nmol/L*); third days after operation (average341.0nmol/L), up to fifth days after operation; returned to the preoperative level (mean362.3nmol/L). Differences between two groups of patients with plasma cortisol changes after operation was not statistically significant. The diameter of<3cm adrenal tumor patients with cortical dysfunction than diameter≥3adrenal tumors. Conclusion:The trend of change of plasma cortisol of adrenal tumor resection for the overall performance of the reduced on the first day after operation, and then slowly rise, after fifth days of cortisol levels most returned to preoperative levels, effects of surgical operation on cortisol secretion of adrenal after the basic end. But between different diseases, operation style, age, tumor size compared to cortisol levels after operation there was no significant difference between. The clinical studies have demonstrated that postoperative adrenal hypofunction in the higher rate, the overall reached43.6%, its mechanism still needs further study.