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 F.
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.
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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
SN - 0300-0664
VL - 68
SP - 513
EP - 519
JO - Clinical Endocrinology
JF - Clinical Endocrinology
IS - 4
ER -