title: Endoscopic bilateral adrenalectomy in patients with ectopic Cushing's syndrome.
abstract: BACKGROUND
  Bilateral adrenalectomy (BLA) is a treatment option to alleviate symptoms in patients with ectopic Cushing's syndrome (ECS) for whom surgical treatment of the responsible nonpituitary tumor is not possible. ECS patients have an increased risk for complications, because of high cortisol levels, poor clinical condition, and metabolic disturbances. This study aims to evaluate the safety and long-term efficacy of endoscopic BLA for ECS.
  
  
  METHODS
  From 1990 to present, 38 patients were diagnosed and treated for ECS in the Erasmus University Medical Center, a tertiary referral center. Twenty-four patients were treated with BLA (21 endoscopic, 3 open), 9 patients were treated medically, and 5 patients could be cured by complete resection of the adrenocorticotropic hormone (ACTH)-producing tumor. The medical records were retrospectively reviewed and entered into a database. For evaluation of the efficacy of BLA, preoperative biochemical and physical symptoms were assessed and compared with postoperative data.
  
  
  RESULTS
  Endoscopic BLA was successfully completed in 20 of the 21 patients; one required conversion to open BLA. Intraoperative complications occurred in two (10%) patients, and postoperative complications occurred in three (14%) patients. Median hospitalization was 9 (2-95) days, and median operating time was 246 (205-347) min. Hypercortisolism was resolved in all patients. Improvements of hypertension, body weight, Cushingoid appearance, impaired muscle strength, and ankle edema were achieved in 87, 90, 65, 61, and 78% of the patients, respectively. Resolution of diabetes, hypokalemia, and metabolic alkalosis was achieved in 33, 89, and 80%, respectively.
  
  
  CONCLUSIONS
  Endoscopic BLA is a safe and effective treatment for patients with ectopic Cushing's syndrome.
authors: Department of Surgery, Erasmus Medical Center, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors: Wijnand J
authors: WJ
authors: Alberda
authors: Casper H J
authors: CH
authors: van Eijck
authors: Richard A
authors: RA
authors: Feelders
authors: Geert
authors: G
authors: Kazemier
authors: Wouter W
authors: WW
authors: de Herder
authors: Jacobus W A
authors: JW
authors: Burger
mesh_terms: D000311:Adrenal Glands / Q000473:pathology*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D003480:Cushing Syndrome / Q000473:pathology / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000473:pathology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult