Faculty Collaboration Database

Impact and timing of bilateral adrenalectomy for refractory adrenocorticotropic hormone-dependent Cushing’s syndrome. Surgery 2013 Dec;154(6):1174-83; discussion 1183-4

Date

01/03/2014

Pubmed ID

24383115

Pubmed Central ID

PMC4271839

DOI

10.1016/j.surg.2013.06.017

Scopus ID

2-s2.0-84887990957 (requires institutional sign-in at Scopus site)   24 Citations

Abstract

INTRODUCTION: In patients with refractory adrenocorticotropic hormone-dependent Cushing’s syndrome,we evaluated steroidogenesis inhibition (SI) and bilateral adrenalectomy (BA) to predict which patients might benefit most from each treatment modality.

METHODS: Clinical data from patients treated 1970-2012 were reviewed retrospectively by treatment group (SI or SI+BA). Validated severity scales were used to calculate metabolic (M) score (hypokalemia, hyperglycemia, hypertension, proximal muscle weakness) and adverse events (AE) score (thrombosis, fracture, infection).

RESULTS: A total of 65 patients (16 pituitary, 49 ectopic) were treated with SI+BA (n = 21,32%) or SI alone (n = 44,68%). Presenting M scores and source of adrenocorticotropic hormone excess (ectopic versus pituitary) were similar. Both groups improved metabolically after treatment. Over one-third of AEs in the SI+BA group occurred within 12 months of presentation. Half (n = 24, 55%) of the patients treated with SI died (median survival, 24.0 months). Steroid excess contributed to 71% of complications. Six SI+BA patients died (29%), including all 3 patients with recurrent Cushing’s syndrome after BA. Minor perioperative complications occurred in 7 patients (33%).

CONCLUSION: Posttreatment M and AE scores improved for all patients and 70% of AEs occurred in SI+BA patients within 12 months of presentation, emphasizing the importance of early operative intervention. These data argue for the safety and efficacy of early BA in selected patients with uncontrollable Cushing’s syndrome.

Author List

Morris LF, Harris RS, Milton DR, Waguespack SG, Habra MA, Jimenez C, Vassilopoulou-Sellin R, Lee JE, Perrier ND, Grubbs EG

Author

Rachel S. Morris MD Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adrenalectomy
Adrenocorticotropic Hormone
Adult
Aged
Child
Cushing Syndrome
Female
Humans
Male
Middle Aged
Retrospective Studies
Time Factors
Treatment Outcome
Young Adult