Improved Quality of Life After Bilateral Laparoscopic Adrenalectomy for Cushing's Disease: A 10-Year Experience.

[~MaryO~]

Improved Quality of Life After Bilateral Laparoscopic Adrenalectomy for Cushing's Disease: A 10-Year Experience.

Original Articles

 

Annals of Surgery. 245(5):790-794, May 2007.

Thompson, Sarah K. MD *; Hayman, Amanda V. MD, MPH *; Ludlam, William H. MD, PhD +; Deveney, Clifford W. MD *; Loriaux, D Lynn MD, PhD +; Sheppard, Brett C. MD *

 

Abstract:

Objective: To determine long-term quality of life after bilateral adrenalectomy for persistent Cushing's disease after transsphenoidal pituitary tumor resection.

 

Summary Background Data: Bilateral adrenalectomy for symptomatic relief of persistent hypercortisolism appears to be an effective treatment option. However, few studies have examined long-term outcomes in this patient population.

 

Methods: Retrospective review of 39 patients treated by bilateral laparoscopic adrenalectomy for Cushing's disease from 1994 to 2004. Patients completed a follow-up phone survey, including our Cushing-specific questionnaire and the SF-12v2 health survey. Patients then refrained from taking their steroid replacement for 24 hours, and serum cortisol and ACTH levels were measured.

 

Results: Three patients died at 12, 19, and 50 months following surgery from causes unrelated to adrenalectomy. The remaining 36 patients all responded to the study questionnaire (100% response rate). Patients were between 3 months and 10 years post-adrenalectomy. We had zero operative mortalities and a 10.3% morbidity rate. Our incidence of Nelson's syndrome requiring clinical intervention was 8.3%; 89% of patients reported an improvement in their Cushing-related symptoms, and 91.7% would undergo the same treatment again. Twenty of 36 (55%) and 29 of 36 (81%) patients fell within the top two thirds of the national average for physical and mental composite scores, respectively, on the SF-12v2 survey. An undetectable serum cortisol level was found in 79.4% of patients.

 

Conclusions: Laparoscopic bilateral adrenalectomy for symptomatic Cushing's disease is a safe and effective treatment option. The majority of patients experience considerable improvement in their Cushing's disease symptoms, and their quality of life equals that of patients initially cured by transsphenoidal pituitary tumor resection.

 

? 2007 Lippincott Williams & Wilkins, Inc.

 

http://www.annalsofsurgery.com/pt/re/annos...#33;8091!-1

[denney]

Interesting article Mary. It seems like I remember in another article a while back that quality of life issues were not reported as even this good after pituitary surgery. It offers some hope and reason for optimism for individuals who don't get a cure after the transsphenoidal surgery.

 

den

[fatnsassy]

Thanks for posting this article MaryO! It is helps to know this, if we ever face this decision down the road. Some days, you just doubt yourself so much and wonder if it would just be better to live with this than to have to live with the consequences of the surgeries. This report is very encouraging in my eyes!

 

Thanks again,

 

Gracie

[SusanM]

Thanks for sharing but I am not convinced of their result. My thought is that 39 patients is not enough to represent a standard for all who have a BLA. I'd be curious to see what other BLAers think.

[kellysue]

Thanks for posting this, Mary!!!

[ReneeD]

It's an interesting report. One question they don't answer that I can see if what the average range of ages is for the participants may be. This may have a determination on the level of recovery. Plus wouldn't you like to know how many return to working full-time, part-time, or never returned o work. Would be an interesting question as well. Also where were these doctors based out of--what institution would be interesting as well.

 

Thanks!

[~MaryO~]

Dr. Ludlam is from Swedish in Seattle currently

 

Dr. Loriaux is from NIH

 

Dr. Sheppard is from OHSU

 

 

The other 2 I don't know.

[pbutton]

Loriaux is at OHSU.

 

Thanks for posting this. I'm trying to learn all I can about bla even though it's not a choice for me right now. Pbutton

 

 

 

Dr. Ludlam is from Swedish in Seattle currently

 

Dr. Loriaux is from NIH

 

Dr. Sheppard is from OHSU

The other 2 I don't know.

[radtravler]

I absolutely agree with this outcome. I am about 2 yrs post -op. And hope this article will help some people who are having to make the decision of whether or not to do a BLA.

 

Thanks Mary,

Denise

[kalimae7371]

I'm glad to see this info posted also. Just as with the disease, I think we all vary in our recovery times based on a lot of factors. In my case I had several unanticipated complications. It also seems that the older you are that maybe it's a little harder ? ? ? Not sure if that's a fair statement or not, just my take on things.

 

For all of those out there that read my posts, I sincerely hope that they don't get discouraged. I'm so looking forward to turning the next corner in my recovery and truly think that I'm well on my way. As Dr. L continues to work with me and get me on more replacements, things will get better.

 

I don't regret my BLA at all!!!

 

Thanks MaryO for all the wonderful info you provide.

 

Amy

[ReneeD]

I don't regret my BLA. In fact, I was just relieved to have the entire craziness over. However, in my case, I do not feel they really told me everything about the outcome after a BLA. They hedged quite a bit about what life is like with a BLA. However, it is definitely an improvement over life with Cushing's. As I have mentioned in the past, I had Cushing's for at least 7 years is my suspicion before I was diagnosed and treated, so I don't really remember what "normal" was like.

 

In the last couple years, I have been experiencing perimenopause symptoms, so that has been interesting re-experiencing a feeling of warmth, being warm a lot of the time, and mood lability occasionally. However, I figure after Cushing's, menopause can't be as bad.

[radtravler]

Hey Renee - have you had your hormones checked ? Or are you already taking some ? You don't have to suffer needlessly with those symptoms. We have enough to deal with !!

 

Denise

[ReneeD]

Hey Renee - have you had your hormones checked ? Or are you already taking some ? You don't have to suffer needlessly with those symptoms. We have enough to deal with !!

 

Denise

 

I am not particularly worried about it at the moment.....thanks for the suggestions. It is just generally a feeling of being warmer than anyone else. My husband has learned that being slightly cool is what makes me happiest. I have found since my BLA that I wilt easily in hotter weather anyway. I would just as soon coast through perimenopause unless my symptoms get really severe. I have only had one truly fully blown earthquake magnitude hot flash that I swear I heard a pop when it hit and bloomed. The rest is just a healthy glow a lot of the time......