Aim was to explore the associations between baseline
cortisol levels and surgery method of primary bilateral macronodular adrenal
hyperplasia (PBMAH). We retrospectively reviewed the clinical features and management of 30 patients (18 females and 12 males) who were diagnosed with PBMAH in our center between 2005 and 2019. Based on surgery method, we divided the patients into two groups: unilateral
adrenalectomy (UA) group; and bilateral
adrenalectomy (BA) group. Serum
cortisol rhythm and 24-hour urinary free
cortisol (UFC/24 h) levels were assayed using chemiluminescence method. Associations between baseline
cortisol levels and BA were assessed using logistic regression. The predictive value of baseline
cortisol levels for BA was calculated using receiver operating characteristic (ROC) curves. Twenty patients (66.7%) underwent UAs and ten patients (33.3%) underwent BAs. After adjusting for age, sex, BMI, SBP, and adrenal volume, the concentrations of baseline serum
cortisol (8 AM, 4 PM, and 0 AM) and UFC/24 h were associated with bilateral
adrenalectomy (all p<0.05). The area under the ROC curve based on 8 AM serum
cortisol level model was larger than that in models based on 4 PM, 0 AM serum
cortisol levels and UFC/24 h, but the differences were non-significant (all p>0.05). According to maximum Youden index criteria, the optimal cutoffs of 8 AM serum
cortisol level and UFC were 26.89 μg/dl and 406.65 μg/24 h, respectively, for BA. The baseline
cortisol levels are positively associated with BA. Increased levels of baseline
cortisol levels may predict higher possibility of BA, which should be confirmed by prospective studies.