Bilateral adrenalectomy: low mortality and morbidity in Cushing's disease.
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.
McCance
D R
DR
Sir George E. Clark Metabolic Unit, Royal Victoria Hospital, Belfast, N. Ireland.
Russell
C F
CF
Kennedy
T L
TL
Hadden
D R
DR
Kennedy
L
L
Atkinson
A B
AB
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
D000324:Adrenocorticotropic Hormone