BILATERAL LAPAROSCOPIC ADRENALECTOMY FOR CORTICOTROPIN-DEPENDENT CUSHING'S SYNDROME:

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http://www.blackwell-synergy.com/doi/abs/1...65.2007.03082.x

 

Clinical Endocrinology

 

To cite this article: John T. Chow, Geoffrey B. Thompson, Clive S. Grant, David R. Farley, Melanie L. Richards, William F. Young Jr.

BILATERAL LAPAROSCOPIC ADRENALECTOMY FOR CORTICOTROPIN-DEPENDENT CUSHING'S SYNDROME: A Review of the Mayo Clinic Experience

Clinical Endocrinology (OnlineAccepted Articles).

doi:10.1111/j.1365-2265.2007.03082.x

 

 

BILATERAL LAPAROSCOPIC ADRENALECTOMY FOR CORTICOTROPIN-DEPENDENT CUSHING'S SYNDROME:

A Review of the Mayo Clinic Experience

 

* John T. Chow11Division of Endocrinology, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA,

* Geoffrey B. Thompson22Department of General Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA,

* Clive S. Grant22Department of General Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA,

* David R. Farley22Department of General Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA,

* Melanie L. Richards22Department of General Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA,

* William F. Young Jr.11Division of Endocrinology, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA

 

*

1Division of Endocrinology, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA 2Department of General Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA

 

Corresponding author and address for reprint requests:

William F. Young Jr., M.D.

Division of Endocrinology, Department of Internal Medicine

Mayo Clinic College of Medicine

200 First Street SW

Rochester, MN 55905

Phone +1-507-284-2511

Fax: +1-507-284-5745

Email: wyoung@mayo.edu

 

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 corticotropin (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.

 

DESIGN: Retrospective review study.

 

PATIENTS: 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).

 

MEASUREMENTS: 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%); 9 (13%) required conversion to open adrenalectomy (OA). Intra-operative complications occurred in 3 patients (4.4%) (2 BLA, 1 OA) and non-operative complications occurred in 11 (16%) patients (8 BLA, 3 OA). There were no perioperative deaths. Median hospitalization was 5.5 days (range, 3 to 28) and 11.9 days (range, 4 to 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.

 

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