Tumors and several types of malignancies including lung cancer, pancreatic cancer, pituitary tumor, and most often adrenal adenoma, may cause hypercortisolism, which requires glucorticoid (GC) replacement following adrenalectomy and/or surgical resection of the tumor. Based on our previous report of a simplified GC therapy scheme and the perioperative observation, we further investigated its efficacy and safety up to 6 months post-surgery in this retrospective cohort study. All patients received no GC before surgery. The i.v. doses of hydrocortisone (HC) were 100 mg during surgery, 100 mg bid on day 0 and day 1, followed by 100 mg qd on the morning of day 2 post-surgery. Patients were grouped by oral reception of either HC or prednisone since day 2. The doses and the withdrawal schedule are shown in Table. We found in adrenal adenoma patients, the adrenocorticotropic hormone (ACTH) levels were normal, and sufficient to stimulate the recovery of the dystrophic adrenal cortex, thus exogenous supplemental ACTH might not be necessary. By 6 months post-surgery, prednisone and HC exhibited similar efficacy in correcting hypertension, hyperglycemia, and hypokalemia (p>0.05). Most patients lost weight. Both groups reported significant improvement in a subjective evaluation questionnaire. HC showed advantages over prednisone in improving liver function (p=0.035), but also caused significant leg edema (p=0.034). Both groups developed adrenal insufficiency (AI) during GC withdrawal, with no significant difference regarding the incidence rate or severity. Most AI symptoms were relieved by resuming the prior oral doses, while the severe cases were treated in hospital. No particular variable was identified as risk factor for AI. The withdrawal process may last longer time for HC than prednisone. HC may be prioritized for patients with hyperglycemia or abnormal liver function, while prednisone may reduce the incidence of leg edema.

 hydrocortisone prednisone 
pathology 22 20 
adrenal adenoma 14/22 16/20 
Cushing's Disease 8/22 4/20 
oral glucorticoid scheme   
dose on day 2 40 mg, tid 10 mg, tid 
withdrawal 20 mg/week 5 mg/week 
average length (month) 6.6 4.9 
correction of symptoms   
hypertension 10/15 12/19 
hyperglycemia 6/11 7/10 
hypokalemia 12/12 11/11 
abnormal liver panel 7/8 2/7 * 
weight loss 20/22 17/20 
adrenal insufficiency 10/22 7/20 
severe case 1/10 1/7 
leg edema 6/22 0/20 * 
 hydrocortisone prednisone 
pathology 22 20 
adrenal adenoma 14/22 16/20 
Cushing's Disease 8/22 4/20 
oral glucorticoid scheme   
dose on day 2 40 mg, tid 10 mg, tid 
withdrawal 20 mg/week 5 mg/week 
average length (month) 6.6 4.9 
correction of symptoms   
hypertension 10/15 12/19 
hyperglycemia 6/11 7/10 
hypokalemia 12/12 11/11 
abnormal liver panel 7/8 2/7 * 
weight loss 20/22 17/20 
adrenal insufficiency 10/22 7/20 
severe case 1/10 1/7 
leg edema 6/22 0/20 * 

Note: This abstract was not presented at the meeting.

Citation Format: Kunlong Tang, Yuting Huang, Shangwen Dong, Peng Gao. Quantitative comparison of hydrocortisone and prednisone in the postoperative hormone therapy of hypercortisolism [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5642. doi:10.1158/1538-7445.AM2017-5642