Endocrine Abstracts

Context: Bilateral adrenalectomy (BADX) has become an important treatment option of Cushing’s syndrome (CS), especially when other treatments have failed. Long-term outcome is not well known.

Objective: To evaluate long-term quality of life (QoL) of patients who underwent BADX for CS compared to other therapeutic options.

Methods: Fourty five patients with all cause CS were identified: 23 patients had BADX and 22 underwent one or more of the following treatments: transphenoidal surgery, medical therapy or radiotherapy. Medical records were retrospectively reviewed and entered into a database. Each patient had to fill three questionnaires to evaluate their QoL: Short Form-36 Health Survey (SF-36) and Cushing QoL questionnaire which are rated over 100 (defined as the best QoL), and Beck depression inventory, the lower limit for depression symptoms being established at 17.

Results: 34 (75.6%) patients had ACTH dependent CS and 11 (24.4%) had ACTH independent CS. Women prevailed (77.8%). The mean age of the patients was 51.3±16.4 years in BADX group and 48.4±16.3 in the other treatment group. Patients who underwent BADX had an impaired QoL in each questionnaire. In the SF-36, both physical and mental scores were altered, respectively at 52.4±20.9 and 53.6±22.9 compared to the other treatment group (69.4±22.5 and 63.3±20.2). The most altered dimension was vitality: 35.4±22.7 vs 51.4±19.2 (P<0.05). Cushing QoL questionnaire was also altered: 49±23.2 vs 59.7±20.1. Beck depression inventory indicates that BADX group has still persistent symptoms of depression, with a score of 17.9±12.7, which is not the case in the other group (11.7±9.6).

Conclusions: Despite clinical remission, patients who underwent BADX have an impaired QoL compared to patients who experienced another therapeutic option for CS. This could be the consequence of a longer exposure to hypercortisolism. Further investigations are needed to understand the causes.