Laparoscopic adrenalectomy in patients with subclinical Cushing syndrome.
BACKGROUND
Subclinical Cushing syndrome in patients with adrenal incidentalomas has been associated with an increased prevalence of the metabolic syndrome and cardiovascular risk. The management of these patients, be it conservative or surgical, is still debated, but there is accumulating evidence that surgery is best and that laparoscopic adrenalectomy, when possible, is the most preferred procedure. Here we present the short- and long-term results of laparoscopic adrenalectomy for subclinical Cushing syndrome and determine the effect of this procedure on components of the metabolic syndrome.


METHODS
Twenty-nine patients, 8 men and 21 women with adrenal incidentalomas and subclinical Cushing syndrome who underwent laparoscopic adrenalectomy, were studied retrospectively. They had undergone postoperative follow-up for improvement or worsening of their arterial blood pressure, body weight, and fasting glucose level for a mean period of 77 months.


RESULTS
Preoperatively, 17 patients (58.6 %) had arterial hypertension, 14 (48.3 %) had a body mass index exceeding 27 kg/m(2), and 12 (41.4 %) had diabetes mellitus. Postoperatively, a decrease in mean arterial pressure was found in 12 patients (70.6 %), a decrease in body mass index in 6 patients (42.9 %), and an improvement in glycemic control in 5 patients (41.7 %).


CONCLUSIONS
Laparoscopic adrenalectomy is beneficial in many patients with subclinical Cushing syndrome because it reduces arterial blood pressure, body weight, and fasting glucose levels. Prospective randomized studies are needed to compare laparoscopic adrenalectomy with a conservative approach and to confirm these results.
3rd Department of Surgery, George Gennimatas General Hospital of Athens, Athens, Greece. iraklisper@gmail.com
Iraklis
I
Perysinakis
Chrisanthi
C
Marakaki
Spyridon
S
Avlonitis
Anastasia
A
Katseli
Evangeline
E
Vassilatou
Lambrini
L
Papanastasiou
George
G
Piaditis
George N
GN
Zografos
D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D003480:Cushing Syndrome / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies