Bilateral Adrenalectomy: Differences between Cushing Disease and Ectopic ACTH-Producing Tumors

Thomas Szabo Yamashita, Alaa Sada, Irina Bancos, William F. Young, Benzon M. Dy, David R. Farley, Melanie L. Lyden, Geoffrey B. Thompson, Travis J. McKenzie

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Background: Bilateral adrenalectomy (BA) is a curative treatment for hypercortisolism in patients with corticotropin (ACTH)-dependent Cushing syndrome. Indications include refractory Cushing’s disease (CD) following failed pituitary surgery, and occult or unresectable ectopic ACTH-producing neoplasms (EA). Methods: This was a single-center, retrospective review (1995–2017) of patients undergoing BA for CD or EA. Demographics, laboratory findings, and intraoperative and postoperative variables were analyzed. Results: Of 137 patients, 83 (61%) had CD and 54 (39%) had EA; 87% of CD patients were female versus 46% of EA patients (p < 0.0001). Mean age at diagnosis was 40 ± 15 years for CD and 49 ± 18 years for EA (p = 0.004). Preoperative serum cortisol concentrations were higher in the EA cohort (63 ± 40 μg/dL) versus the CD cohort (33 ± 19 μg/dL) [p < 0.001], with no significant differences in serum ACTH. Time from diagnosis until adrenalectomy was 54 ± 69 months for CD versus 4 ± 13 for EA (p = 0.002). Most patients underwent minimally invasive surgery (MIS; 86% CD vs. 75% EA; p = 0.19). There was no difference between the rates of conversion to an open approach, intraoperative blood loss, or operative time between groups, and no difference between complications in CD versus EA (p = 1.0). Five-year survival was significantly shorter among the EA cohort (30% for EA vs. 80% for CD; p < 0.001). Conclusion: Patients with EA presented with higher serum cortisol levels compared with patients with CD. EA patients were more likely to require intraoperative transfusion and postoperative intensive care. BA in patients with CD and EA can be performed safely in an MIS fashion, with similar morbidity; however, survival at 5 years was significantly less in the EA cohort.

Original languageEnglish (US)
Pages (from-to)3851-3857
Number of pages7
JournalAnnals of surgical oncology
Volume27
Issue number10
DOIs
StateAccepted/In press - Jan 1 2020

ASJC Scopus subject areas

  • Surgery
  • Oncology

Fingerprint Dive into the research topics of 'Bilateral Adrenalectomy: Differences between Cushing Disease and Ectopic ACTH-Producing Tumors'. Together they form a unique fingerprint.

  • Cite this

    Szabo Yamashita, T., Sada, A., Bancos, I., Young, W. F., Dy, B. M., Farley, D. R., Lyden, M. L., Thompson, G. B., & McKenzie, T. J. (Accepted/In press). Bilateral Adrenalectomy: Differences between Cushing Disease and Ectopic ACTH-Producing Tumors. Annals of surgical oncology, 27(10), 3851-3857. https://doi.org/10.1245/s10434-020-08451-4