SFEBES2018 Poster Presentations Neuroendocrinology and pituitary (25 abstracts)
Outcomes of bilateral adrenalectomy in ACTH-dependent Cushing’s syndrome
Niraj Samani 1, , Athanasios Fountas 1, , Shu Teng Chai 1, , Helena Gleeson 2, , John Ayuk 2, , Wiebke Arlt 1, , Andy Toogood 2, , Neil Gittoes 1, & Niki Karavitaki 1,
1Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; 2Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; 3Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Introduction: Bilateral adrenalectomy (BADx) is a treatment option in ACTH-dependent Cushing’s syndrome refractory to other therapeutic modalities or can be an emergency measure in cases with severe manifestations of hypercortisolaemia.
Aim: To review the outcomes of our patients with ACTH-dependent Cushing’s offered BADx.
Methods: Records of patients with ACTH-dependent Cushing’s managed by BADx and seen in our Department between 1995 and 2017 were reviewed.
Results: Twenty cases were identified; two were excluded due to unavailable clinical data. Fourteen patients (11 females) had Cushing’s disease (CD) (median age at diagnosis: 21 years (11–50)) and 4 (2 females) were considered to have ectopic Cushing’s (ECS) of unknown origin (median age at diagnosis: 48 years (36–54)). Pituitary adenoma was identified in 11 patients (79%) with CD (all microadenomas) and in 1 (25%) with ECS. CD patients underwent BADx after 0 (21%), 1 (14%) or several (65%) transsphenoidal surgeries, radiotherapy (21%) and medical therapies (86%), whilst 3 patients (75%) with ECS had received medical treatment prior to adrenalectomy. BADx was performed via open route in 13/18 patients (72%) and laparoscopically in 5/18 (28%). Surgical complications were documented in seven patients (39%) (6 had open adrenalectomy); 30-days post-operative mortality was 0%. Biochemical cure was achieved in 17 cases (94%). During median follow-up of 10.5 years (1–26), 2 patients had died (both with CD). Based on clinic review, hypertension had improved in 83% and diabetes in 50% of the patients. Development of Nelson’s syndrome was reported in 7 (50%) patients with CD (median interval since BADx 3 years (1–17)) and none had received radiotherapy prior to this diagnosis.
Conclusions: Our series demonstrate that BADx offers a high rate of biochemical control with no peri-operative mortality and considerable improvement in hypertension and diabetes. Nonetheless, the high rate of Nelson’s syndrome requires attention and optimal patient monitoring.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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