Bilateral laparoscopic adrenalectomy for corticotrophin-dependent Cushing's syndrome: a review of the Mayo Clinic experience.

Abstract:

BACKGROUND:There has been a rapid shift from open to laparoscopic approaches in adrenal surgery, but the safety and efficacy of bilateral laparoscopic adrenalectomy (BLA) in patients with corticotrophin (ACTH)-dependent Cushing's syndrome continues to be defined. OBJECTIVE:Review outcomes in the largest series of patients reported to date undergoing BLA for ACTH-dependent Cushing's syndrome. DESIGN:Retrospective review study. PATIENTS:Between January of 1995 and October of 2006, BLA was attempted in 68 patients with ACTH-dependent Cushing's syndrome (26 ectopic ACTH syndrome; 42 persistent pituitary-dependent Cushing's syndrome following pituitary surgery). MEASUREMENTS:Review of peri-operative morbidity and mortality, biochemical parameters and patient-reported symptom response from chart review and mailed questionnaire. RESULTS:BLA was successfully completed in 59 of 68 patients (87%); nine (13%) required conversion to open adrenalectomy (OA). Intra-operative complications occurred in three patients (4.4%) (two BLA, one OA), and non-operative complications occurred in 11 (16%) patients (eight BLA, three OA). There were no peri-operative deaths. Median hospitalization was 5.5 days (range, 3-28) and 11.9 days (range, 4-29) for the BLA and OA groups, respectively. In patients with follow-up data available, all achieved biochemical resolution and at least partial clinical resolution of signs and symptoms associated with hypercortisolism. Resolution of hypertension, diabetes and obesity was achieved in 64%, 29% and 35% of patients carrying those diagnoses prior to surgery, respectively. CONCLUSIONS:This study further supports the role of BLA as an effective treatment option for patients with ACTH-dependent Cushing's syndrome.

journal_name

Clin Endocrinol (Oxf)

journal_title

Clinical endocrinology

authors

Chow JT,Thompson GB,Grant CS,Farley DR,Richards ML,Young WF Jr

doi

10.1111/j.1365-2265.2007.03082.x

subject

Has Abstract

pub_date

2008-04-01 00:00:00

pages

513-9

issue

4

eissn

0300-0664

issn

1365-2265

pii

CEN3082

journal_volume

68

pub_type

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