Bilateral laparoscopic adrenalectomy: a new treatment for difficult cases of congenital adrenal hyperplasia.
OBJECTIVE
In difficult cases of congenital adrenal hyperplasia (CAH), often the child may have normal cortisol levels and elevated androgen levels, or normal androgen levels and elevated cortisol levels, but not normal levels of both. Because bilateral adrenalectomy removes the source of the abnormal androgen production, the authors felt that in some cases it might be more efficacious than conventional medical therapy.


METHODS
Three children with CAH and suboptimal response to medical management underwent bilateral laparoscopic adrenalectomy. Parents were counseled extensively regarding the experimental nature of this treatment and the potential long-term complications.


RESULTS
All children recovered quickly after a mean hospital stay of 1.8 days. Pathologic examination of the removed adrenal glands showed persistent cortical hyperplasia. Follow-up at 6 months indicated marked reduction in abnormal androgen production, which allowed lowering of the steroid dosing to physiologic levels.


CONCLUSIONS
In children with CAH refractory to medical management, bilateral laparoscopic adrenalectomy can be performed safely with almost trivial morbidity. Although early results are very encouraging, the anticipated long-term beneficial effects on growth, short stature, and adult infertility will require years to assess.
Meyers
R L
RL
University of Utah School of Medicine, Primary Children's Medical Center, Salt Lake City 84113, USA.
Grua
J R
JR
D000312:Adrenal Hyperplasia, Congenital / Q000175:diagnosis / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome