Endocrine Abstracts (2004) 7 P122

Retrospective audit of bilateral adrenalectomies with reference to the occurrence of Nelson's syndrome

AJ Green, MT Barakat, JA Lynn & K Meeran


Department of Metabolic Medicine, Hammersmith Campus, Imperial College London, Du Cane Road, London, UK.


Objective

To assess the results of bilateral adrenalectomy and further assess the relevance of Nelson's syndrome as a complication of bilateral adrenalectomy.

Patients

33 patients treated by bilateral adrenalectomy at the Hammersmith Hospital were identified (earliest operation performed in 1958). Although all bilateral adrenalectomies in recent years were included, it was not possible to confirm that all bilateral adrenalectomies were identified between 1958 and 1990 due to deficient theatre records.

Design

Retrospective analysis of outcome measures.

Methods

Patients were divided into 4 groups depending on their initial diagnosis;

1.Pituitary-dependent Cushing's disease

2.Ectopic ACTH syndrome

3.Bilateral adrenal hyperplasia

4.Other causes

Main outcome measures

Indications for bilateral adrenalectomy; survival following bilateral adrenalectomy; and the occurrence of Nelson's syndrome.

Results

-Indications for bilateral adrenalectomy in patients with Cushing's disease were as follows: 50% after failed previous transsphenoidal surgery (only treatment); 31% as a primary treatment modality; 13% after failed previous radiotherapy (only treatment); and 6% after failed previous transsphenoidal surgery and radiotherapy.

Indications for bilateral adrenalectomy in patients with ectopic ACTH syndrome were as follows: 70% as a primary treatment after failure to locate a tumour; 20% as a primary treatment as a result of an unresectable tumour source; and 10% after failed previous surgery and radiotherapy.

-Ninety-one percent of patients were alive at time of data collection; follow-up ranged from 0.5 to 43 years following bilateral adrenalectomy.

-Nine percent of patients have developed Nelson's syndrome (and this only occurred in patients with pituitary dependent Cushing's).

Conclusions

In the set of patients studied, Nelson's syndrome was not a common complication, and only occurred in the patients with pituitary-dependent Cushing's treated with bilateral adrenalectomy.

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