Figure 4 Intraoperative and postoperative findings.A. Robotic-assisted laparoscopic positioning and trocar placement via transabdominal approach. B .The grossly excised tissue post-surgery appears yellowish and solid, with nodular hyperplasia observed. C . Post-surgical hematoxylin and eosin (H&E) stained pathological section is consistent with adrenal adenoma findings (×100).
Postoperative hormone supplementation protocol: Hydrocortisone 100 mg was administered intravenously during the surgery. On the day after the surgery, hydrocortisone 200 mg was administered intravenously. On the first postoperative day, hydrocortisone 200 mg was given intravenously (125 mg at 8:00 AM and 75 mg at 4:00 PM), and the following day, the dose was reduced to 150 mg (100 mg at 8:00 AM and 50 mg at 4:00 PM). After resuming normal oral intake, prednisone 30 mg per day was prescribed orally, with a gradual reduction to 20 mg per day upon discharge, depending on the patient’s condition. The dose was further reduced by 2.5 mg every 4 weeks.
Regular postoperative follow-up was conducted for 2 months, with no symptoms of adrenal insufficiency, such as anorexia, nausea, tachycardia, apathy, or fatigue and drowsiness. The patient’s cortisol diurnal rhythm was restored (Table 1), menstruation was regular, and the patient’s weight decreased by 5 kg. No significant symptoms of adrenal insufficiency or adrenal crisis were observed during the follow-up period. Plasma cortisol and ACTH levels will continue to be monitored, and medications may be gradually reduced or discontinued once adrenal cortical function is confirmed to have returned to normal.