title: A critical reappraisal of bilateral adrenalectomy for ACTH-dependent Cushing's syndrome.
abstract: OBJECTIVE
  Our aim was to review short- and long-term outcomes of patients treated with bilateral adrenalectomy (BADx) in ACTH-dependent Cushing's syndrome.
  
  
  METHODS
  We reviewed the literature and analysed our experience with 53 patients treated with BADx since 1990 in our institution.
  
  
  RESULTS
  BADx is considered if ACTH-dependent Cushing's syndrome is refractory to other treatment modalities. In Cushing's disease (CD), BADx is mainly used as an ultima ratio after transsphenoidal surgery and medical therapies have failed. In these cases, the time span between the first diagnosis of CD and treatment with BADx is relatively long (median 44 months). In ectopic Cushing's syndrome, the time from diagnosis to BADx is shorter (median 2 months), and BADx is often performed as an emergency procedure because of life-threatening complications of severe hypercortisolism. In both situations, BADx is relatively safe (median surgical morbidity 15%; median surgical mortality 3%) and provides excellent control of hypercortisolism; Cushing's-associated signs and symptoms are rapidly corrected, and co-morbidities are stabilised. In CD, the quality of life following BADx is rapidly improving, and long-term mortality is low. Specific long-term complications include the development of adrenal crisis and Nelson's syndrome. In ectopic Cushing's syndrome, long-term mortality is high but is mostly dependent on the prognosis of the underlying malignant neuroendocrine tumour.
  
  
  CONCLUSIONS
  BADx is a relatively safe and highly effective treatment, and it provides adequate control of long-term co-morbidities associated with hypercortisolism.
authors.affiliation: Medizinische Klinik und Poliklinik IVKlinikum der Ludwig-Maximilians-Universität München, Ziemssenstraße 1, D-80336 Munich, GermanyMax-Planck-Institut für PsychiatrieMunich, GermanyChirurgische Klinik und Poliklinik - InnenstadtKlinikum der Ludwig-Maximilians-Universität München, Munich, Germany Martin.Reincke@med.uni-muenchen.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Reincke
authors.affiliation: Medizinische Klinik und Poliklinik IVKlinikum der Ludwig-Maximilians-Universität München, Ziemssenstraße 1, D-80336 Munich, GermanyMax-Planck-Institut für PsychiatrieMunich, GermanyChirurgische Klinik und Poliklinik - InnenstadtKlinikum der Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Ritzel
authors.affiliation: Medizinische Klinik und Poliklinik IVKlinikum der Ludwig-Maximilians-Universität München, Ziemssenstraße 1, D-80336 Munich, GermanyMax-Planck-Institut für PsychiatrieMunich, GermanyChirurgische Klinik und Poliklinik - InnenstadtKlinikum der Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Oßwald
authors.affiliation: Medizinische Klinik und Poliklinik IVKlinikum der Ludwig-Maximilians-Universität München, Ziemssenstraße 1, D-80336 Munich, GermanyMax-Planck-Institut für PsychiatrieMunich, GermanyChirurgische Klinik und Poliklinik - InnenstadtKlinikum der Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Berr
authors.affiliation: Medizinische Klinik und Poliklinik IVKlinikum der Ludwig-Maximilians-Universität München, Ziemssenstraße 1, D-80336 Munich, GermanyMax-Planck-Institut für PsychiatrieMunich, GermanyChirurgische Klinik und Poliklinik - InnenstadtKlinikum der Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Günter
authors.initials: G
authors.lastname: Stalla
authors.affiliation: Medizinische Klinik und Poliklinik IVKlinikum der Ludwig-Maximilians-Universität München, Ziemssenstraße 1, D-80336 Munich, GermanyMax-Planck-Institut für PsychiatrieMunich, GermanyChirurgische Klinik und Poliklinik - InnenstadtKlinikum der Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Hallfeldt
authors.affiliation: Medizinische Klinik und Poliklinik IVKlinikum der Ludwig-Maximilians-Universität München, Ziemssenstraße 1, D-80336 Munich, GermanyMax-Planck-Institut für PsychiatrieMunich, GermanyChirurgische Klinik und Poliklinik - InnenstadtKlinikum der Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Nicole
authors.initials: N
authors.lastname: Reisch
authors.affiliation: Medizinische Klinik und Poliklinik IVKlinikum der Ludwig-Maximilians-Universität München, Ziemssenstraße 1, D-80336 Munich, GermanyMax-Planck-Institut für PsychiatrieMunich, GermanyChirurgische Klinik und Poliklinik - InnenstadtKlinikum der Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Schopohl
authors.affiliation: Medizinische Klinik und Poliklinik IVKlinikum der Ludwig-Maximilians-Universität München, Ziemssenstraße 1, D-80336 Munich, GermanyMax-Planck-Institut für PsychiatrieMunich, GermanyChirurgische Klinik und Poliklinik - InnenstadtKlinikum der Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Beuschlein
mesh_terms: D049913:ACTH-Secreting Pituitary Adenoma / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D000236:Adenoma / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D000315:Adrenalectomy; D000324:Adrenocorticotropic Hormone / Q000378:metabolism*; D003480:Cushing Syndrome / Q000209:etiology / Q000378:metabolism / Q000601:surgery*; D005938:Glucocorticoids / Q000627:therapeutic use; D020249:Hormone Replacement Therapy / Q000379:methods; D006801:Humans; D047748:Pituitary ACTH Hypersecretion / Q000209:etiology / Q000378:metabolism / Q000601:surgery*; D010902:Pituitary Gland / Q000378:metabolism / Q000601:surgery*; D011878:Radiotherapy; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D000324:Adrenocorticotropic Hormone