Bilateral laparoscopic adrenalectomy for corticotrophin–dependent Cushing's syndrome: a review of the Mayo Clinic experience

Authors


William F. Young Jr, Division of Endocrinology, Department of Internal Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA. Tel.: +1-507-284-2511; Fax: +1-507-284-5745; E-mail: wyoung@mayo.edu

Summary

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 corticotrophin (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%); nine (13%) required conversion to open adrenalectomy (OA). Intra-operative complications occurred in three patients (4·4%) (two BLA, one OA), and non-operative complications occurred in 11 (16%) patients (eight BLA, three OA). There were no peri-operative deaths. Median hospitalization was 5·5 days (range, 3–28) and 11·9 days (range, 4–29) 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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