Endocrine Abstracts

Introduction: Bilateral adrenalectomy (BA) is rarely applied as a therapeutic procedure. It serves as a life-saving treatment in patients with persistent Cushing’s disease after an ineffective pituitary surgery or in ectopic ACTH production. Other indications for BA are: bilateral adrenocortical adenomas, congenital adrenal hyperplasia and bilateral phaeochromocytoma in patients with hereditary paraganglioma-phaeochromocytoma (PPS/PGL) syndromes. It is also a procedure of choice in bilateral adrenal metastases. The aim of the study was to determine the indications to BA in patients hospitalized in our ward between 2001 and 2012.

Material and methods: 12 patients (7F; 5M) aged 19–72 years. Studies were based on retrospective analysis of medical records.

Results: Patients were divided into three groups. Group 1:7 patients (4F; 3M) with bilateral phaeochromocytoma (MEN2 syndrome – four patients, PPS/PGL-1 patient, von Hippel – Linadu – one patient, one woman with sporadic bilateral phaeochromocytoma). Among three patients from group 2 the indications to BA were adrenal metastases of renal clear cell carcinoma in two and a metastasis to one adrenal gland coexisting with adenoma of the other in one case. Group 3: two women with Cushing’s disease. One of them was operated 31 years earlier propter corticotroph microadenoma and the second – because of atypical pituitary macroadenoma refractory to radiation, neurosurgical and pharmacological treatment. Patients with congenital disorders (six), Cushing’s disease (two) and one with metastasis and adenoma, underwent synchronous bilateral or two-stage adrenal surgery. Female with sporadic bilateral phaeochromocytoma was operated twice at interval of 10 years and two patients with adrenal metastases at intervals of 3–4 years. Two patients died after a year and 3 years due to the progression of the underlying disease. The remaining are still alive (from 2 to 31 years after surgery).

Conclusions: Currently, the prevalent indication to BA is bilateral phaeochromocytoma, mostly in the course of underlying hereditary neoplasmatic syndrome.