Adrenal surgery for hypercortisolism--surgical aspects.
BACKGROUND
Patients with endogenous hypercortisolism are thought to be at high risk for adrenalectomy and may experience significant postoperative surgical mortality/morbidity.


METHODS
From 1981 through 1991, 91 patients underwent adrenal resection for endogenous hypercortisolism. Causes were adrenal-dependent Cushing's syndrome (50%), pituitary-dependent Cushing's syndrome (27%), and an ectopic adrenocorticotropic hormone-secreting tumor (23%). Causes of adrenal-dependent Cushing's syndrome were adrenocortical adenoma (72%), bilateral nodular hyperplasia (20%), and adrenocortical carcinoma (8%). Comparative mean length of hospitalization for patients undergoing unilateral anterior versus posterior approach was 8 versus 6 days, and bilateral anterior versus posterior was 11 versus 6 days.


RESULTS
Operative mortality was 2.6%. Only one patient had a wound infection, and no patient had either a venous thrombosis or a pulmonary embolism. Delayed wound healing occurred in three patients.


CONCLUSIONS
(1) Adrenal surgery can be performed today with low morbidity/mortality. (2) Although there is an effect of hypercortisolism on wound healing, infection, diabetes, hypertension, coronary artery disease, and pulmonary embolism, it was possible to perform adrenalectomy surgically with acceptable morbidity and mortality. (3) These results may serve as a standard against which laparoscopic adrenalectomy may be compared.
van Heerden
J A
JA
Department of Gastroenterologic, Mayo Clinic, Rochester, Minn 55905, USA.
Young
W F
WF
Grant
C S
CS
Carpenter
P C
PC
D000236:Adenoma / Q000601:surgery*; D000306:Adrenal Cortex Neoplasms / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000601:surgery; D000311:Adrenal Glands / Q000473:pathology; D000315:Adrenalectomy / Q000379:methods* / Q000401:mortality; D000308:Adrenocortical Hyperfunction / Q000209:etiology / Q000601:surgery*; D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D000328:Adult; D000368:Aged; D002276:Carcinoid Tumor / Q000601:surgery; D003480:Cushing Syndrome / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010190:Pancreatic Neoplasms / Q000601:surgery; D010673:Pheochromocytoma / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D011471:Prostatic Neoplasms / Q000601:surgery; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000601:surgery; D016896:Treatment Outcome
D000324:Adrenocorticotropic Hormone