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Abstract
Background. Bilateral adrenalectomy provides an effective surgical option for patients with Cushing's
syndrome. Knowledge of the long-term outcome of the patient who has undergone adrenalectomy
is an important factor in determining management strategy in this situation.
Methods. Fifty consecutive patients undergoing bilateral adrenalectomy (7980 to 1997) were
studied. Twenty-five had Cushing's disease, 18 ectopic adrenocorticotrophic hormone
production, and seven primary adrenal hyperplasia. Median age was 43 years (range,
74 to 82 years); male-to-female ratio was 13:37. At follow-up 17 patients had died;
the remaining 33 were interviewed at a median of 62 months after operation.
Results. Operative mortality was 4%. Late mortality included two patients with Cushing's disease
who died of progressive pituitary disease and eight patients with ectopic adrenocorticotrophic
hormone production who died of metastatic disease. Five-year survival was: 100% for
patient with adrenal hyperplasia, 86% for patients with Cushing's disease, and 39%
for patients with ectopic adrenocorticotrophie hormone production. Of 33 survivors
followed for a median of 62 months, three (9%) were hospitalized with acute steroid
deficiency. The principal complaint among survivors was chronic fatigue (60%). Only
10 (30%) patients had no symptoms. No steroid-related complications resulted after
16 surgical procedures subsequently performed. Of 20 survivors of Cushing's disease,
three had Nelson's syndrome.
Conclusions. Bilateral adrenalectomy for Cushing's syndrome is associated with occasional morbidity
and mortality consequent to adrenal insufficiency. These patients suffered a high
incidence of chronic physical complaints that may reflect the residual sequelae of
chronic Cushing's syndrome. An active program of long-term rehabilitation is essential.
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Article info
Footnotes
☆Presented at the Fifteenth Annual Meeting of the American Association of Endocrine Surgeons, Dearborn, Mich., April 17–19, 1994.
Identification
Copyright
© 1994 Published by Elsevier Inc.
