Endocrine Abstracts

Aim of the study: to analyze surgical outcome in patients who underwent unilateral or bilateral adrenalectomy for hypercortisolism.

Methods: retrospective study including patients operated on between January 1994 and June 2005.

Results: adrenalectomies for hypercortisolism were performed in 18 patients (5 males, 13 females, mean age 43.6±16.1 years). Indications were cortisol producing adenoma (n=10), adrenocortical carcinoma (n=1), macronodular adrenal hyperplasia (n=1), pituitary-dependent Cushing’s syndrome (n=3), ectopic ACTH syndrome (n=3). Open surgery was required initially in 4 patients (bilateral adrenalectomy in 2 patients and unilateral adrenalectomy in 2 patients). Laparoscopic adrenalectomy (LA) was successfully performed for 14 patients, in 4 (17%) of whom the laparoscopic approach needed to be converted to a laparotomy. Post-operative hospital stay was 4.9±2.2 days.

There was no intraoperative complication. The rate of postoperative complications was 66%. There was no serious complication after unilateral adrenalectomy for any indication and after bilateral adrenalectomy for Cushing’s disease, but bilateral adrenalectomy for ectopic ACTH syndrome was associated with major complications (severe haemorrhage, acute pancreatitis, septicemia, lung infection, renal failure) and recurrent abdominal surgery for complications in all patients. In all, 4 patients (22%) died: 1 with adrenocortical carcinoma (ASA score 2) died 71 months after adrenalectomy, the 3 other patients with ectopic ACTH syndrome (ASA score 4) all died in the year (respectively 1, 2, 6.5 months) following bilateral adrenalectomy. The mean follow up was 71 months (range from 1 to 132 months). Except for the patients who died, resolution of the symptoms of hypercortisolism was complete. 2 patients had acute adrenal failure 1 month after unilateral adrenalectomy. 1 patient developed Nelson’s syndrome 18 months after bilateral adrenalectomy for Cushing’s disease although he had had hemi-pituitary removal 5 months before adrenalectomy.

Conclusion: bilateral adrenalectomy for ectopic ACTH syndrome was followed by major complications and recurrent abdominal surgery for all patients, all of whom died within one year. In contrast, bilateral adrenalectomy could be safely and effectively employed to treat Cushing’s disease although open laparotomy was often required. Unilateral LA is a good treatment of an adrenal adenoma, with a low rate of postoperative complications.