title: Results and long-term follow-up after unilateral adrenalectomy for ACTH-independent hypercortisolism in a series of fifty patients.
abstract: Untreated hypercortisolism is a fatal state, causing functional disability. Even after successful treatment, clinical recovery is slower than the biochemical one, but data about clinical results, well-being and working capacity after surgery are scarce. This retrospective study aimed at evaluating the long-term outcome of patients after adrenalectomy for ACTH-independent hypercortisolism by the analysis of the clinical results, the survival and the subjective well-being status after surgery. Clinical data in 50 patients suffering from ACTH-independent hypercortisolism and treated between 1980 and 2000 by unilateral adrenalectomy were recorded. At a mean follow-up of 134 months, 3 patients were dead. All the surviving patients were asked to self estimate the physical and psychological recovery after surgery. After surgery, 100% of patients were biochemically cured. A clinical recovery was observed in most cases: obesity in 59.6% and hypertension in 57.5%. Bone mass density (BMD) significantly improved (+20%). The long-term mortality rate did not differ from normal population. Subjectively, a full recovery was confirmed by 95.6% of the surviving patients; it was correlated with the subjective feeling of physical recovery (95.6%) and regained working ability (93.3%). Despite of biochemical and clinical cure, no subjective improvement of the psychological conditions was observed in 26.7% of cases. At long-term follow-up, most objective symptoms of Cushing's syndrome (CS) disappear; subjective health and working ability are often regained, but a psychological impairment could persist in spite of a successful treatment.
authors.affiliation: Endocrine Surgery Unit, Department of Surgical and Gastroenterological Sciences, University of Padua, Padua, Italy. maurizio.iacobone@unipd.it
authors.forename: M
authors.initials: M
authors.lastname: Iacobone
authors.forename: F
authors.initials: F
authors.lastname: Mantero
authors.forename: S M
authors.initials: SM
authors.lastname: Basso
authors.forename: F
authors.initials: F
authors.lastname: Lumachi
authors.forename: G
authors.initials: G
authors.lastname: Favia
mesh_terms: D000315:Adrenalectomy; D000324:Adrenocorticotropic Hormone / Q000502:physiology; D000328:Adult; D000368:Aged; D003480:Cushing Syndrome / Q000473:pathology / Q000523:psychology / Q000601:surgery*; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000324:Adrenocorticotropic Hormone