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Abstract:
Objective: Our aim was to review short-and long-term outcomes of
patients treated with bilateral adrenalectomy (BADx) in ACTH-dependent
Cushing's syndrome.
Methods: We reviewed the literature and analysed our experience with 53
patients treated with BADx since 1990 in our institution.
Results: BADx is considered if ACTH-dependent Cushing's syndrome is
refractory to other treatment modalities. In Cushing's disease (CD),
BADx is mainly used as an ultima ratio after transsphenoidal surgery and
medical therapies have failed. In these cases, the time span between the
first diagnosis of CD and treatment with BADx is relatively long (median
44 months). In ectopic Cushing's syndrome, the time from diagnosis to
BADx is shorter (median 2 months), and BADx is often performed as an
emergency procedure because of life-threatening complications of severe
hypercortisolism. In both situations, BADx is relatively safe (median
surgical morbidity 15%; median surgical mortality 3%) and provides
excellent control of hypercortisolism; Cushing's-associated signs and
symptoms are rapidly corrected, and co-morbidities are stabilised. In
CD, the quality of life following BADx is rapidly improving, and
long-term mortality is low. Specific long-term complications include the
development of adrenal crisis and Nelson's syndrome. In ectopic
Cushing's syndrome, long-term mortality is high but is mostly dependent
on the prognosis of the underlying malignant neuroendocrine tumour.
Conclusion: BADx is a relatively safe and highly effective treatment,
and it provides adequate control of long-term co-morbidities associated
with hypercortisolism.
