Surgical group
ADRENAL INSUFFICIENCY
In patients referred for surgery, spironolactone/eplerenone therapy was continued, as tolerated, until the day of operation. Laparoscopic adrenalectomy, using standard operative techniques, was performed by a single endocrine surgeon at two of the participating sites, unless the patient or referring physician preferred local referral. The serum cortisol value at the conclusion of the 72-h preparatory dexamethasone before the MTO scan was used to guide the clinical concern about potential post-operative adrenal insufficiency. Where appropriate, supplementary hydrocortisone was provided and withdrawn after subsequent clinical and biochemical reassessment. The outcomes from surgery were assessed biochemically and clinically at 3 and 6 months after surgery, and at 12 and 24 months in patients recruited in earlier years of the study. At each visit, the same measurements were performed as at the baseline visit, except that NT-pro BNP, troponin and 24-h urine measurements were repeated only once, at the 6-month post-surgery visit.