Bilateral laparoscopic adrenalectomy for corticotrophin-dependent Cushing's syndrome: A review of the Mayo Clinic experience

John T. Chow, Geoffrey B. Thompson, Clive S. Grant, David R. Farley, Melanie L. Richards, William Francis Young

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Background: There has been a rapid shift from open to laparoscopic approaches in adrenal surgery, but the safety and efficacy of bilateral laparoscopic adrenalectomy (BLA) in patients with corticotrophin (ACTH)-dependent Cushing's syndrome continues to be defined. Objective: Review outcomes in the largest series of patients reported to date undergoing BLA for ACTH-dependent Cushing's syndrome. Design: Retrospective review study. Patients: Between January of 1995 and October of 2006, BLA was attempted in 68 patients with ACTH-dependent Cushing's syndrome (26 ectopic ACTH syndrome; 42 persistent pituitary-dependent Cushing's syndrome following pituitary surgery). Measurements: Review of peri-operative morbidity and mortality, biochemical parameters and patient-reported symptom response from chart review and mailed questionnaire. Results: BLA was successfully completed in 59 of 68 patients (87%); nine (13%) required conversion to open adrenalectomy (OA). Intra-operative complications occurred in three patients (4.4%) (two BLA, one OA), and non-operative complications occurred in 11 (16%) patients (eight BLA, three OA). There were no peri-operative deaths. Median hospitalization was 5.5 days (range, 3-28) and 11.9 days (range, 4-29) for the BLA and OA groups, respectively. In patients with follow-up data available, all achieved biochemical resolution and at least partial clinical resolution of signs and symptoms associated with hypercortisolism. Resolution of hypertension, diabetes and obesity was achieved in 64%, 29% and 35% of patients carrying those diagnoses prior to surgery, respectively. Conclusions: This study further supports the role of BLA as an effective treatment option for patients with ACTH-dependent Cushing's syndrome.

Original languageEnglish (US)
Pages (from-to)513-519
Number of pages7
JournalClinical Endocrinology
Volume68
Issue number4
DOIs
StatePublished - Apr 2008

Fingerprint

Cushing Syndrome
Adrenalectomy
Adrenocorticotropic Hormone
Ectopic ACTH Syndrome
Pituitary ACTH Hypersecretion
Signs and Symptoms
Hospitalization
Retrospective Studies
Obesity

ASJC Scopus subject areas

  • Endocrinology

Cite this

Bilateral laparoscopic adrenalectomy for corticotrophin-dependent Cushing's syndrome : A review of the Mayo Clinic experience. / Chow, John T.; Thompson, Geoffrey B.; Grant, Clive S.; Farley, David R.; Richards, Melanie L.; Young, William Francis.

In: Clinical Endocrinology, Vol. 68, No. 4, 04.2008, p. 513-519.

Research output: Contribution to journalArticle

Chow, John T. ; Thompson, Geoffrey B. ; Grant, Clive S. ; Farley, David R. ; Richards, Melanie L. ; Young, William Francis. / Bilateral laparoscopic adrenalectomy for corticotrophin-dependent Cushing's syndrome : A review of the Mayo Clinic experience. In: Clinical Endocrinology. 2008 ; Vol. 68, No. 4. pp. 513-519.
@article{77066ca9429b4125bbaa4bc1a6fc2678,
title = "Bilateral laparoscopic adrenalectomy for corticotrophin-dependent Cushing's syndrome: A review of the Mayo Clinic experience",
abstract = "Background: There has been a rapid shift from open to laparoscopic approaches in adrenal surgery, but the safety and efficacy of bilateral laparoscopic adrenalectomy (BLA) in patients with corticotrophin (ACTH)-dependent Cushing's syndrome continues to be defined. Objective: Review outcomes in the largest series of patients reported to date undergoing BLA for ACTH-dependent Cushing's syndrome. Design: Retrospective review study. Patients: Between January of 1995 and October of 2006, BLA was attempted in 68 patients with ACTH-dependent Cushing's syndrome (26 ectopic ACTH syndrome; 42 persistent pituitary-dependent Cushing's syndrome following pituitary surgery). Measurements: Review of peri-operative morbidity and mortality, biochemical parameters and patient-reported symptom response from chart review and mailed questionnaire. Results: BLA was successfully completed in 59 of 68 patients (87{\%}); nine (13{\%}) required conversion to open adrenalectomy (OA). Intra-operative complications occurred in three patients (4.4{\%}) (two BLA, one OA), and non-operative complications occurred in 11 (16{\%}) patients (eight BLA, three OA). There were no peri-operative deaths. Median hospitalization was 5.5 days (range, 3-28) and 11.9 days (range, 4-29) for the BLA and OA groups, respectively. In patients with follow-up data available, all achieved biochemical resolution and at least partial clinical resolution of signs and symptoms associated with hypercortisolism. Resolution of hypertension, diabetes and obesity was achieved in 64{\%}, 29{\%} and 35{\%} of patients carrying those diagnoses prior to surgery, respectively. Conclusions: This study further supports the role of BLA as an effective treatment option for patients with ACTH-dependent Cushing's syndrome.",
author = "Chow, {John T.} and Thompson, {Geoffrey B.} and Grant, {Clive S.} and Farley, {David R.} and Richards, {Melanie L.} and Young, {William Francis}",
year = "2008",
month = "4",
doi = "10.1111/j.1365-2265.2007.03082.x",
language = "English (US)",
volume = "68",
pages = "513--519",
journal = "Clinical Endocrinology",
issn = "0300-0664",
publisher = "Wiley-Blackwell",
number = "4",

}

TY - JOUR

T1 - Bilateral laparoscopic adrenalectomy for corticotrophin-dependent Cushing's syndrome

T2 - A review of the Mayo Clinic experience

AU - Chow, John T.

AU - Thompson, Geoffrey B.

AU - Grant, Clive S.

AU - Farley, David R.

AU - Richards, Melanie L.

AU - Young, William Francis

PY - 2008/4

Y1 - 2008/4

N2 - Background: There has been a rapid shift from open to laparoscopic approaches in adrenal surgery, but the safety and efficacy of bilateral laparoscopic adrenalectomy (BLA) in patients with corticotrophin (ACTH)-dependent Cushing's syndrome continues to be defined. Objective: Review outcomes in the largest series of patients reported to date undergoing BLA for ACTH-dependent Cushing's syndrome. Design: Retrospective review study. Patients: Between January of 1995 and October of 2006, BLA was attempted in 68 patients with ACTH-dependent Cushing's syndrome (26 ectopic ACTH syndrome; 42 persistent pituitary-dependent Cushing's syndrome following pituitary surgery). Measurements: Review of peri-operative morbidity and mortality, biochemical parameters and patient-reported symptom response from chart review and mailed questionnaire. Results: BLA was successfully completed in 59 of 68 patients (87%); nine (13%) required conversion to open adrenalectomy (OA). Intra-operative complications occurred in three patients (4.4%) (two BLA, one OA), and non-operative complications occurred in 11 (16%) patients (eight BLA, three OA). There were no peri-operative deaths. Median hospitalization was 5.5 days (range, 3-28) and 11.9 days (range, 4-29) for the BLA and OA groups, respectively. In patients with follow-up data available, all achieved biochemical resolution and at least partial clinical resolution of signs and symptoms associated with hypercortisolism. Resolution of hypertension, diabetes and obesity was achieved in 64%, 29% and 35% of patients carrying those diagnoses prior to surgery, respectively. Conclusions: This study further supports the role of BLA as an effective treatment option for patients with ACTH-dependent Cushing's syndrome.

AB - Background: There has been a rapid shift from open to laparoscopic approaches in adrenal surgery, but the safety and efficacy of bilateral laparoscopic adrenalectomy (BLA) in patients with corticotrophin (ACTH)-dependent Cushing's syndrome continues to be defined. Objective: Review outcomes in the largest series of patients reported to date undergoing BLA for ACTH-dependent Cushing's syndrome. Design: Retrospective review study. Patients: Between January of 1995 and October of 2006, BLA was attempted in 68 patients with ACTH-dependent Cushing's syndrome (26 ectopic ACTH syndrome; 42 persistent pituitary-dependent Cushing's syndrome following pituitary surgery). Measurements: Review of peri-operative morbidity and mortality, biochemical parameters and patient-reported symptom response from chart review and mailed questionnaire. Results: BLA was successfully completed in 59 of 68 patients (87%); nine (13%) required conversion to open adrenalectomy (OA). Intra-operative complications occurred in three patients (4.4%) (two BLA, one OA), and non-operative complications occurred in 11 (16%) patients (eight BLA, three OA). There were no peri-operative deaths. Median hospitalization was 5.5 days (range, 3-28) and 11.9 days (range, 4-29) for the BLA and OA groups, respectively. In patients with follow-up data available, all achieved biochemical resolution and at least partial clinical resolution of signs and symptoms associated with hypercortisolism. Resolution of hypertension, diabetes and obesity was achieved in 64%, 29% and 35% of patients carrying those diagnoses prior to surgery, respectively. Conclusions: This study further supports the role of BLA as an effective treatment option for patients with ACTH-dependent Cushing's syndrome.

UR - http://www.scopus.com/inward/record.url?scp=40749086366&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=40749086366&partnerID=8YFLogxK

U2 - 10.1111/j.1365-2265.2007.03082.x

DO - 10.1111/j.1365-2265.2007.03082.x

M3 - Article

C2 - 17970770

AN - SCOPUS:40749086366

VL - 68

SP - 513

EP - 519

JO - Clinical Endocrinology

JF - Clinical Endocrinology

SN - 0300-0664

IS - 4

ER -