A challenging case of laparoscopic synchronous bilateral adrenalectomy for Cushing's disease. Case report

Abstract

IntroductionLaparoscopic adrenalectomy is a treatment option in patients with Cushing's syndrome. Preoperative comorbities as well as surgical and anesthesiological difficulties can make the procedure challenging.Presentation of the caseWe present the case of a 53-year-old obese man diagnosed with Cushing's syndrome, also suffering from other endocrine pathologies, neurofibromatosis type 2, cardiomiopathy with severe hypertrophy and diastolic dysfunction, deep vein thrombosis (DVT) and obstructive sleep apnea syndrome (OSAS).After multidisciplinary team discussion of the case, the patient underwent laparoscopic synchronous bilateral adrenalectomy. The laparoscopic approach was a part of a balanced enhanced recovery program which resulted in uneventful discharge in 4 days.ConclusionLaparoscopic synchronous bilateral adrenalectomy is feasible and effective and should be considered also in patients with wide preoperative comorbidities and challenging intraoperative management, as long as the patient is meticulously studied preoperatively. An approach including a multidisciplinary team discussion is recommended.

Factors predicting prolonged glucocorticoid therapy in patients with adrenal insufficiency after laparoscopic adrenalectomy

“…[ 6 ], the technique underwent many refinements. To date, in experienced hands, laparoscopic adrenalectomy is considered a gold standard even for the treatment of large adrenal masses [ 7 , 8 ] as well as in patients presenting with urgent clinical pictures [ 9 ] or requiring bilateral surgical treatment [ [10] , [11] , [12] ].…”

Better clinical benefits and potential cost saving of an enhanced recovery pathways for laparoscopic adrenalectomy

“…Furthermore, few studies comparing ERPs with conventional perioperative management for patients undergoing laparoscopic adrenalectomy have investigated implementation and maintenance costs, post-discharge patient-reported outcomes, and socioeconomic impact (15), which may significantly affect the cost-effectiveness of ERPs (16,17). Before widespread, a formal economic evaluation assessing both the costs and benefits of these pathways is required to determine the cost-effectiveness.…”