For a patient with a large pheochromocytoma, how would you evaluate for possible autonomous cortisol co-secretion prior to adrenalectomy to assess need for risk of glucocorticoid withdrawal postoperatively?
Although rare, glucocorticoids carry the risk of precipitating a pheochromocytoma crisis.
Systemic corticosteroids may trigger phaeochromocytoma crisis
1 Answer
Mednet MemberInvited Expert
Endocrinology · Washington University School of Medicine
Answered on
From a practical standpoint, and given that this is rare, it is reasonable to check a postoperative day 1 (POD1) AM cortisol and decide then whether cortisol replacement is needed.
You can also check ACTH, AM and PM cortisol to assess diurnal variation, and DHEAS pre-op to get some idea.
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