Bilateral laparoscopic adrenalectomy for corticotrophin-dependent Cushing's syndrome: a review of the Mayo Clinic experience.
BACKGROUND
There has been a rapid shift from open to laparoscopic approaches in adrenal surgery, but the safety and efficacy of bilateral laparoscopic adrenalectomy (BLA) in patients with corticotrophin (ACTH)-dependent Cushing's syndrome continues to be defined.


OBJECTIVE
Review outcomes in the largest series of patients reported to date undergoing BLA for ACTH-dependent Cushing's syndrome.


METHODS
Retrospective review study.


METHODS
Between January of 1995 and October of 2006, BLA was attempted in 68 patients with ACTH-dependent Cushing's syndrome (26 ectopic ACTH syndrome; 42 persistent pituitary-dependent Cushing's syndrome following pituitary surgery).


METHODS
Review of peri-operative morbidity and mortality, biochemical parameters and patient-reported symptom response from chart review and mailed questionnaire.


RESULTS
BLA was successfully completed in 59 of 68 patients (87%); nine (13%) required conversion to open adrenalectomy (OA). Intra-operative complications occurred in three patients (4.4%) (two BLA, one OA), and non-operative complications occurred in 11 (16%) patients (eight BLA, three OA). There were no peri-operative deaths. Median hospitalization was 5.5 days (range, 3-28) and 11.9 days (range, 4-29) for the BLA and OA groups, respectively. In patients with follow-up data available, all achieved biochemical resolution and at least partial clinical resolution of signs and symptoms associated with hypercortisolism. Resolution of hypertension, diabetes and obesity was achieved in 64%, 29% and 35% of patients carrying those diagnoses prior to surgery, respectively.


CONCLUSIONS
This study further supports the role of BLA as an effective treatment option for patients with ACTH-dependent Cushing's syndrome.
Chow
John T
JT
Division of Endocrinology, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Thompson
Geoffrey B
GB
Grant
Clive S
CS
Farley
David R
DR
Richards
Melanie L
ML
Young
William F
WF
D000315:Adrenalectomy / Q000401:mortality*; D000324:Adrenocorticotropic Hormone; D000368:Aged; D003480:Cushing Syndrome / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000401:mortality*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000324:Adrenocorticotropic Hormone