Glucocorticoid Replacement Therapy Duration Following Unilateral Adrenalectomy in Cushing's Syndrome: A Comprehensive Review
Bibliographic record
Abstract
Cushing syndrome (CS) is a rare endocrine disorder characterized by continuous exposure to abnormally high cortisol levels, most often from endogenous hypercortisolism. The standard treatment for ACTH‑independent CS is unilateral adrenalectomy (UA), which carries a risk of postoperative adrenal insufficiency due to hypothalamic‑pituitary‑adrenal (HPA) axis suppression. This review examines glucocorticoid replacement therapy (GRT) after UA. Recent evidence supports tailoring GRT duration to each patient’s adrenal recovery. Under moderate stress, the adrenal cortex normally produces the equivalent of 10 mg hydrocortisone or 2.5 mg prednisolone daily, and glucocorticoids must be tapered gradually, sometimes over several months to more than a year, to prevent insufficiency. Not all patients recover by six months. Some with overt CS require 11–12 months or longer. Unrecognized subclinical hypercortisolism or pheochromocytoma can increase perioperative risk, so close monitoring of hormone levels and clinical symptoms is essential. In conclusion, personalized GRT, step‑wise dose reduction, and vigilant endocrine follow‑up are important to safe recovery and improved long‑term outcomes after UA.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".