Incidentaloma medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
The mainstay of treatment for [disease name] is [therapy].
Medical Therapy
Perioperative management of patients with SCS
- Patients with Cushing’s syndrome or SCS have adequate circulating glucocorticoids and therefore do not require glucocorticoid therapy during surgery.
- Such patients can safely undergo surgical resection of their tumor, have their cortisol levels measured in the morning of postoperative d 1
- be started on hydrocortisone 30 mg in the morning and 10 mg in the early afternoon until the result of the cortisol level becomes available (73).
- This would provide an early and accurate evaluation of surgical success in patients with underlying Cushing’s syndrome or SCS.
- Another approach would be to cover all patients with glucocorticoids perioperatively and evaluate their HPA axis at a later date (71, 74).
Aldosteronoma
Preoperative management
- The majority of patients with primary aldosteronism need to proceed with bilateral adrenal venous sampling to confirm the presence of a unilateral source for hyperaldosteronism.
- Some experts recommend adrenal vein sampling in all patients with primary aldosteronism older than 40 yr due to the increased prevalence of adrenal incidentaloma in such a population (118).
- Adrenalectomy in patients with a documented unilateral source of primary aldosteronism is more cost effective compared with lifelong medical therapy.
- Medical therapy with mineralocorticoid receptor antagonists should be reserved for those who are unable or unwilling to undergo surgery (44).
- Laparoscopic adrenalectomy compared to an open procedure is associated with a shorter hospital stay, fewer complications, and faster recovery.
- Resection of the adrenal tumor in a patient with APA will result in resolution of hypokalemia and improvement in hypertension in almost all patients.
Postoperative management
- Potassium supplementation and mineralocorticoid receptor antagonists should be stopped on postoperative day1
- Close monitoring of serum potassium.
- A temporary state of hypoaldosteronism may also develop in some patients with primary aldosteronism postoperatively.
- In the majority of cases, this condition can be managed by increasing salt intake.