Postoperative management of patients after endocrine surgery - adrenal surgery

Overview

Postoperative management after adrenalectomy requires anticipating the specific hormonal consequences of removing the operated adrenal tissue - most critically, glucocorticoid replacement after removal of a cortisol-secreting tumour, given the contralateral adrenal gland's chronic suppression from the tumour's autonomous cortisol production
Relevant to postoperative care following adrenalectomy for any functioning adrenal tumour (Cushing syndrome, phaeochromocytoma) or, less commonly, for a non-functioning mass with concerning features

Chronic autonomous cortisol secretion from a functioning adrenal tumour suppresses the contralateral (normal) adrenal gland via negative feedback on pituitary ACTH - after removing the tumour-bearing gland, the remaining suppressed gland cannot immediately resume adequate cortisol production, creating a predictable period of adrenal insufficiency requiring glucocorticoid replacement until the suppressed axis recovers (which can take months)

Post-phaeochromocytoma-resection monitoring focuses on haemodynamic stability, since removal of the catecholamine-secreting tumour can cause a precipitous fall in catecholamine levels and resultant hypotension, particularly if pre-operative alpha-blockade preparation was inadequate
Post-Cushing-tumour-resection monitoring focuses on cortisol levels and clinical adrenal insufficiency symptoms, guiding glucocorticoid replacement dose and taper

Perioperative and postoperative glucocorticoid replacement (stress-dose initially, tapering to physiological replacement) is essential after resection of a cortisol-secreting tumour, continued until the suppressed contralateral adrenal axis recovers - confirmed by short Synacthen testing once replacement is being weaned
Careful haemodynamic monitoring and management (fluid/vasopressor support as needed) after phaeochromocytoma resection given the abrupt catecholamine withdrawal

Adrenal insufficiency after cortisol-secreting tumour removal (a predictable, expected complication requiring proactive replacement, not a treatment failure), post-phaeochromocytoma haemodynamic instability, contralateral adrenal axis recovery timeline (can take months)
Glucocorticoid replacement after resection of a cortisol-secreting adrenal tumour is an anticipated, standard part of postoperative care, not a sign of surgical complication - the contralateral adrenal gland has been chronically suppressed by the tumour and needs time (sometimes months) to recover normal function, during which replacement prevents an adrenal crisis

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