title: Bilateral laparoscopic adrenalectomy for corticotrophin-dependent Cushing's syndrome: a review of the Mayo Clinic experience.
abstract: 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.
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Chow
authors.forename: Geoffrey B
authors.initials: GB
authors.lastname: Thompson
authors.forename: Clive S
authors.initials: CS
authors.lastname: Grant
authors.forename: David R
authors.initials: DR
authors.lastname: Farley
authors.forename: Melanie L
authors.initials: ML
authors.lastname: Richards
authors.forename: William F
authors.initials: WF
authors.lastname: Young
mesh_terms: 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
chemical_list: D000324:Adrenocorticotropic Hormone