Article

Laparoscopic adrenalectomy for adrenocorticotropin-dependent Cushing's syndrome.

Division of Endocrinology, Metabolism, and Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
Journal of Clinical Endocrinology &amp Metabolism (impact factor: 6.5). 05/2001; 86(4):1596-9. pp.1596-9
Source: PubMed

ABSTRACT Bilateral adrenalectomy is indicated for the treatment of ACTH-dependent Cushing's syndrome when the tumorous source of ACTH hypersecretion cannot be identified or removed. Potential advantages of laparoscopic over open adrenalectomy include shorter hospitalization, decreased requirement for postoperative analgesia, and decreased postoperative morbidity due to incisional complications. Bilateral laparoscopic adrenalectomy performed for the treatment of ACTH-dependent Cushing's syndrome was attempted in 19 patients at our institution between 1995 and 1998. Conversion to an open procedure was required in three patients. All patients who underwent bilateral laparoscopic adrenalectomy were subsequently followed to assess the outcome of this intervention. Twelve patients with pituitary-dependent Cushing's syndrome and four with ectopic ACTH syndrome underwent successful bilateral laparoscopic adrenalectomy. All patients experienced resolution of the signs and symptoms (e.g. proximal myopathy, hirsutism, and emotional lability) of Cushing's syndrome as well as weight loss, improved glucose tolerance, and improved control of blood pressure. No residual cortisol secretion was detected in the patients. Bilateral laparoscopic adrenalectomy is a safe and effective treatment for Cushing's syndrome when the ACTH-secreting neoplasm cannot be removed.

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    James K Liu, Maria Fleseriu, Johnny B Delashaw, Ivan S Ciric, William T Couldwell
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    ABSTRACT: Cushing disease is considered an aggressive pituitary endocrinopathy because of the devastating effects from untreated hypercortisolemia. Although they are histologically benign, these adrenocorticotropic hormone (ACTH)-secreting pituitary tumors are associated with significant morbidity and premature death. Currently, transsphenoidal surgery is the primary treatment of Cushing disease associated with an ACTH-secreting pituitary tumor, resulting in remission rates ranging from about 50 to 90%. Some patients, however, will not achieve sustained remission after transsphenoidal surgery and can exhibit persistent or recurrent Cushing disease that requires multimodal treatment to achieve remission. In these patients, options for treatment include repeat transsphenoidal resection, radiation therapy (including conventional fractionated radiation therapy and stereotactic radiosurgery), and medical therapy. Despite undergoing multiple treatment modalities, some patients may ultimately require bilateral adrenalectomy for definitive treatment to eliminate hypercortisolemia associated with Cushing disease. In this article, the authors review the treatment options for patients who have persistent or recurrent Cushing disease after unsuccessful transsphenoidal surgery. The indications, current results reported in the literature, and complications of each treatment modality are discussed.
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Keywords

19 patients
 
ACTH hypersecretion
 
ACTH-dependent Cushing's syndrome
 
ACTH-secreting neoplasm
 
Bilateral adrenalectomy
 
Bilateral laparoscopic adrenalectomy
 
Cushing's syndrome
 
ectopic ACTH syndrome
 
effective treatment
 
emotional lability
 
glucose tolerance
 
laparoscopic
 
pituitary-dependent Cushing's syndrome
 
proximal myopathy
 
residual cortisol secretion
 
shorter hospitalization
 
signs
 
successful bilateral laparoscopic adrenalectomy
 
tumorous source
 
weight loss
 

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