Glucocorticoid Replacement Therapy Duration Following Unilateral Adrenalectomy in Cushing's Syndrome: A Comprehensive Review

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.