title: Bilateral adrenalectomy: low mortality and morbidity in Cushing's disease.
abstract: OBJECTIVE
  We assessed the current role of bilateral adrenalectomy in the overall management strategy of hypercortisolism.
  
  
  METHODS
  Retrospective review of case notes.
  
  
  METHODS
  Twenty-six patients (20F/6M); mean age 46 years (range 15-70 years), median duration of follow-up 5.25 years (0.6-19.1 years) who had undergone bilateral adrenalectomy at the Royal Victoria Hospital since 1972. Eighteen had had prior transsphenoidal surgery which did not control the hypercortisolism.
  
  
  METHODS
  Morbidity, mortality, incidence of Nelson's syndrome.
  
  
  RESULTS
  Surgery was performed through bilateral postero-lateral incisions (20 patients) or a long epigastric incision (six patients). The mean combined weight of the adrenals at surgery was 11.2 g. Twenty patients received subcutaneous heparin and 18 antibiotic prophylaxis peri and post-operatively. There was no operative mortality. Minor complications included one post-operative wound infection and a small pneumothorax requiring drainage. Major complications occurred in two other patients, both with pre-existing invasive pituitary tumours and considered at high risk because of age and general debility. One patient had a massive pulmonary embolus and the other a subphrenic abscess post-operatively. This latter patient, the only mortality, died from an unrelated cause three years post-operatively. Six patients have subsequently undergone pituitary surgery and three have received external pituitary irradiation therapy for expanding tumours.
  
  
  CONCLUSIONS
  Bilateral adrenalectomy, in experienced hands, is a relatively safe and useful management option in patients with hypercortisolism. Growth of a pituitary adenoma post-operatively is now the most worrying complication.
authors.affiliation: Sir George E. Clark Metabolic Unit, Royal Victoria Hospital, Belfast, N. Ireland.
authors.forename: D R
authors.initials: DR
authors.lastname: McCance
authors.forename: C F
authors.initials: CF
authors.lastname: Russell
authors.forename: T L
authors.initials: TL
authors.lastname: Kennedy
authors.forename: D R
authors.initials: DR
authors.lastname: Hadden
authors.forename: L
authors.initials: L
authors.lastname: Kennedy
authors.forename: A B
authors.initials: AB
authors.lastname: Atkinson
mesh_terms: D000293:Adolescent; D000311:Adrenal Glands / Q000473:pathology; D000315:Adrenalectomy; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D003480:Cushing Syndrome / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009929:Organ Size; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000324:Adrenocorticotropic Hormone