Analysis of diagnosis and treatment of adrenal crisis after adrenal surgery

doi:10.3877/cma.j.issn.1674-3253.2026.01.012

Abstract

Abstract:

Objective

To summarize the diagnosis and treatment of adrenal crisis after unilateral adrenal surgery.

Methods

The clinical data of 12 patients with adrenal crisis after adrenal surgery from January 2018 to June 2023 in our hospital were retrospectively analyzed.

Results

Among the 12 patients, there were 1 case of adrenal hyperplasia, 2 cases of aldosteronomas, 1 case of adenoma with Cushing's syndrome, 7 cases of non-functional adenomas, 1 case of adrenal cyst with hemorrhage. All patients underwent laparoscopic unilateral adrenal surgery, with 11 cases of adrenal resection and 1 case of adrenal tumor resection. Adrenal crisis occurred within 48 hours after surgery in all patients. All patients were cured and discharged after treatment with glucocorticoid supplementation, fluid resuscitation and correction of electrolyte disturbances.

Conclusion

Adrenal crisis can occur after unilateral adrenalectomy regardless of tumor functionality, with the high-risk period being within 48 hours postoperatively. Early recognition and timely treatment lead to favorable prognosis.

Key words: Adrenal crisis, Adrenalectomy, Postoperative complications, Glucocorticoids

Yingzhao Huo, Chuangming Liu, Ren Liang. Analysis of diagnosis and treatment of adrenal crisis after adrenal surgery[J]. Chinese Journal of Endourology(Electronic Edition), 2026, 20(01): 84-88.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhqjmnmwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3253.2026.01.012

https://zhqjmnmwkzz.cma-cmc.com.cn/EN/Y2026/V20/I01/84

References 30

[1]	Bancos I, Hahner S, Tomlinson J, et al. Diagnosis and management of adrenal insufficiency[J]. Lancet Diabetes Endocrinol, 2015, 3(3): 216-226. DOI: 10.1016/S2213-8587(14)70142-1.
[2]	Martel-Duguech L, Poirier J, Bourdeau I, et al. Diagnosis and management of secondary adrenal crisis[J]. Rev Endocr Metab Disord, 2024, 25(3): 619-637. DOI: 10.1007/s11154-024-09877-x.
[3]	Lousada LM, Mendonca BB, Bachega TASS. Adrenal crisis and mortality rate in adrenal insufficiency and congenital adrenal hyperplasia[J]. Arch Endocrinol Metab, 2021, 65(4): 488-494. DOI: 10.20945/2359-3997000000392.
[4]	Ahmadifard A. Adrenal insufficiency, data deficiency: a crisis waiting to happen[J]. Br Dent J, 2022, 233(7): 560. DOI: 10.1038/s41415-022-5129-2.
[5]	Martin-Grace J, Tomkins M, O' Reilly MW, et al. Iatrogenic adrenal insufficiency in adults[J]. Nat Rev Endocrinol, 2024, 20(4): 209-227. DOI: 10.1038/s41574-023-00929-x.
[6]	Claessen KMJA, Andela CD, Biermasz NR, et al. Clinical unmet needs in the treatment of adrenal crisis: importance of the patient’s perspective[J]. Front Endocrinol, 2021, 12: 701365. DOI: 10.3389/fendo.2021.701365.
[7]	Kienitz T, Bechmann N, Deutschbein T, et al. Adrenal crisis–definition, prevention and treatment: results from a Delphi survey[J]. Horm Metab Res, 2024, 56(1): 10-15. DOI: 10.1055/a-2130-1938.
[8]	Allolio B. Extensive expertise in endocrinology. Adrenal crisis[J]. Eur J Endocrinol, 2015, 172(3): R115-R124. DOI: 10.1530/EJE-14-0824.
[9]	Simpson H, Tomlinson J, Wass J, et al. Guidance for the prevention and emergency management of adult patients with adrenal insufficiency[J]. Clin Med, 2020, 20(4): 371-378. DOI: 10.7861/clinmed.2019-0324.
[10]	Dineen R, Thompson CJ, Sherlock M. Adrenal crisis: prevention and management in adult patients[J]. Ther Adv Endocrinol Metab, 2019, 10: 2042018819848218. DOI: 10.1177/2042018819848218.
[11]	Martin-Grace J, Dineen R, Sherlock M, et al. Adrenal insufficiency: Physiology, clinical presentation and diagnostic challenges[J]. Clin Chim Acta, 2020, 505: 78-91. DOI: 10.1016/j.cca.2020.01.029.
[12]	Sekhon SS, Crick K, Myroniuk TW, et al. Adrenal insufficiency: investigating prevalence and healthcare utilization using administrative data[J]. J Endocr Soc, 2021, 6(4): bvab184. DOI: 10.1210/jendso/bvab184.
[13]	Beuschlein F, Else T, Bancos I, et al. European society of endocrinology and endocrine society joint clinical guideline: diagnosis and therapy of glucocorticoid-induced adrenal insufficiency[J]. J Clin Endocrinol Metab, 2024, 109(7): 1657-1683. DOI: 10.1210/clinem/dgae250.
[14]	Diana H, Diana R, Daniela R, et al. Adrenal crisis as initial manifestation of bilateral adrenal hemorrhage due to antiphospholipid syndrome: a case report[J]. SAGE Open Med Case Rep, 2023, 11: 2050313X231181653. DOI: 10.1177/2050313X231181653.
[15]	Lundholm MD, Ambalavanan J, Rao PP. Primary adrenal insufficiency in adults: When to suspect, how to diagnose and manage[J]. Cleve Clin J Med, 2024, 91(9): 553-562. DOI: 10.3949/ccjm.91a.23072.
[16]	Rushworth RL, Torpy DJ. The changing epidemiology of adrenal insufficiency: iatrogenic factors predominate[J]. J Endocr Soc, 2023, 7(3): bvad017. DOI: 10.1210/jendso/bvad017.
[17]	Rushworth RL, Falhammar H, Torpy DJ. Adrenal crisis and adrenal insufficiency admissions in patients 30-59 years: contribution of psychosocial factors[J]. Clin Endocrinol, 2025, 102(3): 245-254. DOI: 10.1111/cen.15166.
[18]	Broersen LHA, van Haalen FM, Kienitz T, et al. The incidence of adrenal crisis in the postoperative period of HPA axis insufficiency after surgical treatment for Cushing's syndrome[J]. Eur J Endocrinol, 2019, 181(2): 201-210. DOI: 10.1530/EJE-19-0202.
[19]	Utsumi T, Iijima S, Sugizaki Y, et al. Laparoscopic adrenalectomy for adrenal tumors with endocrine activity: Perioperative management pathways for reduced complications and improved outcomes[J]. Int J Urol, 2023, 30(10): 818-826. DOI: 10.1111/iju.15218.
[20]	Rushworth RL, Torpy DJ, Falhammar H. Adrenal crisis[J]. N Engl J Med, 2019, 381(9): 852-861. DOI: 10.1056/nejmra1807486.
[21]	Puar THK, Stikkelbroeck NMML, Smans LCCJ, et al. Adrenal crisis: still a deadly event in the 21st century[J]. Am J Med, 2016, 129(3): 339.e1-339.e9. DOI: 10.1016/j.amjmed.2015.08.021.
[22]	Shaikh S, Nagendra L, Shaikh S, et al. Adrenal failure: an evidence-based diagnostic approach[J]. Diagnostics, 2023, 13(10): 1812. DOI: 10.3390/diagnostics13101812.
[23]	Lentz S, Collier KC, Willis G, et al. Diagnosis and management of adrenal insufficiency and adrenal crisis in the emergency department[J]. J Emerg Med, 2022, 63(2): 212-220. DOI: 10.1016/j.jemermed.2022.06.005.
[24]	Bornstein SR, Allolio B, Arlt W, et al. Diagnosis and treatment of primary adrenal insufficiency: an endocrine society clinical practice guideline[J]. J Clin Endocrinol Metab, 2016, 101(2): 364-389. DOI: 10.1210/jc.2015-1710.
[25]	Peel A, Rushworth RL, Torpy DJ. Novel agents to treat adrenal insufficiency: findings of preclinical and early clinical trials[J]. Expert Opin Investig Drugs, 2024, 33(2): 115-126. DOI: 10.1080/13543784.2024.2311207.
[26]	Lewis A, Thant AA, Aslam A, et al. Diagnosis and management of adrenal insufficiency[J]. Clin Med, 2023, 23(2): 115-118. DOI: 10.7861/clinmed.2023-0067.
[27]	Shepherd LM, Schmidtke KA, Hazlehurst JM, et al. Interventions for the prevention of adrenal crisis in adults with primary adrenal insufficiency: a systematic review[J]. Eur J Endocrinol, 2022, 187(1): S1-S20. DOI: 10.1530/EJE-21-1248.
[28]	Heidarpour M, Shafie D, Eshraghi R, et al. Adrenal crisis-induced cardiogenic shock (ACCS): a comprehensive review[J]. Heart Fail Rev, 2025, 30(1): 227-246. DOI: 10.1007/s10741-024-10458-y.
[29]	Mebrahtu TF, Morgan AW, Keeley A, et al. Dose dependency of iatrogenic glucocorticoid excess and adrenal insufficiency and mortality: a cohort study in England[J]. J Clin Endocrinol Metab, 2019, 104(9): 3757-3767. DOI: 10.1210/jc.2019-00153.
[30]	Ahmet A, Gupta A, Malcolm J, et al. Approach to the patient: preventing adrenal crisis through patient and clinician education[J]. J Clin Endocrinol Metab, 2023, 108(7): 1797-1805. DOI: 10.1210/clinem/dgad003.

Please choose a citation manager

Content to export