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Background. Patients with endogenous hypercortisolism are thought to be at high risk for adrenalectomy
and may experience significant postoperative surgical mortality/morbidity.
Methods From 1981 through 1991, 91 patients underwent adreral resection for endogenous hypercortisolism.
Causes were adrenal-dependent Cushing's syndrome (50%), pituitary-dependent Cushing's
syndrome (27%), and an ectopic adrenocorticotropic hormone-secreting tumor(23%). Causes
of adrenal-dependent Cushing's syndrome were adrenocortical adenoma (72%), bilateral
nodular hyperplasia (20%), and adrenocortical carcinoma (8%). Comparative mean length
of hospitalization for patients undergoing unilateral anterior versus posterior approach
was 8 versus 6 days, and bilateral anterior versus posterior was 11 versus 6 days.
Results. Operative mortality was 2.6%. Only one patient had a wound infection, and no patient
had either a venous thrombosis or a pulmonary embolism. Delayed wound healing occurred
in three patients.
Conclusions. (1) Adrenal surgery can be performed today with low morbidity/mortality. (2) Although
there is an effect of hypercortisolism on wound healing, infection, diabetes, hypertension,
coronary artery disease, and pulmonary embolism, it was possible to perform adrenalectomy
surgically with acceptable morbidity and mortality. (3) These results may serve as
a standard against which laparoscopic adrenalectomy may be compared.
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References
- The Cushing's syndrome: an update on diagnostic tests.Ann Intern Med. 1990; 112: 434-444
- Urine free cortisol in the high-dose dexamethasone suppression test for the differential diagnosis of the Cushing syndrome.Ann Intern Med. 1992; 116: 211-217
- Diagnosis of corticotropin-producing bronchial carcinoid tumors causing Cushing's syndrome.in: Mayo Clin Proc. 65. 1990: 1314-1321
- Petrosal sinus sampling with and without corticotropin-releasing hormone for the differential diagnosis of Cushing's syndrome.N Engl J Med. 1991; 325: 897-905
- Subtotal adrenalectomy for Cushing's syndrome:a preliminary report of 29 cases.Ann Surg. 1951; 134: 464-472
- Surgical treatment of adrenocortical hyperplasia: 20-year experience.J Urol. 1973; 109: 321-324
- Adrenal gland surgery: preoperative location of lesions, histologic findings and outcome of surgery.Acta Chir Scand. 1986; 152: 577-581
- Long-term results of treatment of Cushing's disease by adrenalectomy.Eur J Surg. 1991; 157: 461-464
- Operative treatment, surgical approach, and related complications in 195 operations upon the adrenal gland.Surg Gynecol Obstet. 1972; 135: 261-266
- The role of adrenalectomy in Cushing's syndrome.Surgery. 1990; 108: 1079-1084
- Current status of adrenalectomy for Cushing's disease.Surgery. 1985; 98: 1127-1133
- Anderson W Boyd's pathology for the surgeon. 8th ed. WB Saunders, Philadelphia1967
- Effects of cortisone on the healing of disrupted abdominal wounds.Am J Surg. 1961; 101: 189-191
- The effect of methylprednisolone and vitamin A on wound healing.Acta Chir Scand. 1981; 147: 307-312
- The effect of delayed administration, of corticosteroids on wound contraction.Ann Surg. 1971; 173: 214-218
- Effects of cortisone and vitamin A on wound healing.Ann Surg. 1968; 167: 324-328
- Effect of vitamin A on reversing the inhibitory effect of cortisone on healing of open wounds in animals and man.Ann Surg. 1969; 170: 633-641
- Increased factor VIII associated activities in Cushing's syndrome: a probable hypercoagulable state.Thromb Haemost. 1982; 47: 116-117
- Thromboembolic complications, heparin treatment and increase in coagulation factors in Cushing's syndrome.Acta Med Scand. 1976; 199: 95-98
- Surgical treatment of Cushing's disease.J Neurosurg. 1987; 66: 204-212
- Transsphenoidal surgery for Cushing's disease.J R Soc Med. 1986; 79: 262-269
- Transsphenoidal removal of pituitarymicroadenoma in Cushing's disease.in: Mayo Clin Proc. 53. 1978: 24-28
- The complex of myxomas, spotty pigmentation and endocrine overactivity.Medicine. 1985; 64: 270-283
- Primary adrenal causes of Cushing's syndrome: diagnosis and surgical management.Ann Surg. 1989; 210: 59-68
- Residual adrenocortical function after bilateral adrenalectomy for pituitary-dependent Cushing's syndrome.J Clin Endocrinol Metab. 1992; 75: 1211-1214
- Bilateral adrenalectomy: low mortality and morbidity in Cushing's disease.Clin Endocrinol. 1993; 39: 315-321
- Natural history of pituitary-adrenal recovery following longterm suppression with corticosteroids.J Clin Endocrinol Metab. 1965; 25: 11-16
- The pituitary corticotroph is not the rate limiting step in the postoperative recovery of the hypothalamic-pituitary-adrenal axis in patients with Cushing Syndrome.J Clin Endocrinol Metab. 1993; 77: 173-177
Article info
Publication history
Accepted:
September 29,
1994
Identification
Copyright
© 1995 Mosby-Year Book, Inc. Published by Elsevier Inc.
