The Study Of Plasma Cortisol Hormone Changes After Unilateral Adrenalectomy

Objective:To investigate the changes of plasma basal cortisol level and its influencing factors after laparoscopic unilateral adrenalectomy in patients with adrenal hypertensive hypertension,and to provide reference for perioperative hormone replacement therapy.Method:Collection of basic clinical data of patients undergoing laparoscopic unilateral adrenalectomy in our department from October 2015 to October 2017,Including gender,age range(persons older than 50 years and those less than or equal to 50 years old),surgical side,postoperative pathology,preoperative,postoperative 3 days,postoperative 7 days,postoperative 30 days(Ask the patient to review on time after surgery)from 7:00 to 9:00 in the morning rest Peripheral blood plasma cortisol levels.Comprehensive analysis of postoperative plasma basal cortisol levels,and analysis of patient gender,age,surgical side,postoperative pathology,preoperative cortisol on postoperative plasma cortisol levels in patients.SPSS22.0 software is used for data processing.Result:There were 75 cases in this group that met the exclusion criteria,including 31 cases of male patients and 44 cases of female patients.The preoperative plasma basal cortisol concentration was 204.10±61.54 ng/ml,the plasma cortisol concentration was 117.99±46.58 ng/ml at 3 days after operation,and the plasma basal cortisol concentration was 177.48±31.51 ng/ml at 7 days after surgery.The 30-day plasma basal cortisol concentration was 189.27±25.60 ng/ml.The plasma cortisol decreased significantly on the third day after the operation,the average decrease was 87 ng/ml,The plasma cortisol level was increased on the 7th day and 30 th day after surgery.But the plasma basal cortisol concentration was still slightly lower than the preoperative level on the 30 th day after surgery.Three of the patients had symptoms of adrenocortical insufficiency postoperatively and were improved after short-term corticosteroid replacement therapy.No obvious adrenal insufficiency occurred in the other patients.Patients were grouped according to gender,age group,surgical side,postoperative pathology,preoperative cortisol and compared between groups.After repeated measurement data analysis of variance found: There was no significant difference in the trend of plasma basal cortisol concentration between sex,age,operative side and postoperative pathology(P<0.05).The comparison of two groups of pre operation cortisol and preoperative non cortisol.The preoperative cortisol increase in plasma cortisol concentration decreased more than non-cortisol hyperactivity,and the recovery was slow.The difference between the two groups was statistically significant(P>0.05).Conclusion:Adrenocortical hypertensive patients,drug control of poor blood pressure or adrenal hyperplasia with more obvious endocrine symptoms may consider surgical removal of unilateral adrenal glands,can achieve the purpose of controlling blood pressure to reduce plasma basal hormone levels.A partial adrenocortical dysfunction may occur in some patients after unilateral adrenalectomy.With the compensatory changes in the secretory function of the contralateral adrenal glands,clinical symptoms disappear.the overall trend of plasma cortisol hormone levels showed a low level at 3 days after surgery,a significant increase at 7 days after surgery,but the plasma hormone increased slowly after 7 days.The recovery tendency of plasma cortisol after unilateral adrenalectomy was not affected by gender,age,surgical side and postoperative cortical pathology,but was related to preoperative cortisol concentration.