Favorable long-term outcomes of bilateral adrenalectomy in Cushing's disease

Oßwald, Andrea; Plomer, Eva; Dimopoulou, Christina; Milian, Monika; Blaser, Rainer; Ritzel, Katrin; Mickisch, Anne; Knerr, Ferengis; Stanojević, Milan; Hallfeldt, Klaus; Schopohl, Jochen; Kuhn, Klaus A.; Stalla, Günter; Beuschlein, Felix; Reincke, Martín

doi:10.1530/eje-14-0214

Cited by 77 publications

(58 citation statements)

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“…Significant improvement in quality of life after BADx was achieved in 82-89% of the patients. Although quality of life in patients with Cushing's syndrome significantly improved in all of the studies after BADx, it was still definitely and permanently reduced as compared to a matched healthy control population (4,43,44). This appears to be unrelated to BADx itself, seeing as patients with CD following successful transsphenoidal surgery are similarly affected by an impaired quality of life.…”

Section: Clinical Outcomes and Complicationsmentioning

confidence: 83%

“…In fact, in the Munich cohort of 34 CD patients, the median time between diagnosis of CD and BADx was 44 months. The patients underwent BADx after one (62%) or several (38%) transsphenoidal surgeries, radiation (21%) and medical therapies (45%) (4).…”

Section: When Is Badx In Acth-dependent Cushing's Syndrome Indicated?mentioning

confidence: 99%

“…Those studies demonstrated reduced blood loss and shortened hospital stays but similar mortality, morbidity and quality of life. Currently, the most commonly used technique is simultaneous bilateral laparoscopic BADx with the lateral transabdominal transperitoneal laparoscopic approach, although posterior retroperitoneoscopic adrenalectomy is advocated in some centres (30,39) Because of the severe co-morbidities and the bilateral approach, patients with Cushing's syndrome have a higher risk for surgery-related morbidity and mortality than do patients with The open circles depict studies published since 2013, including surgical mortality (4,30,41) and total mortality (4,30).…”

Section: Surgical Outcomementioning

confidence: 99%

“…However, in a recent study, three out of 21 patients had clinical recurrence based on unilateral or bilateral single adrenal bed nodules (30). Five studies have formally addressed quality of life after successful BADx in patients with Cushing's syndrome (4,38,42,43,44). Significant improvement in quality of life after BADx was achieved in 82-89% of the patients.…”

Section: Clinical Outcomes and Complicationsmentioning

confidence: 99%

“…On the other hand, BADx is an essential treatment option for patients with Cushing's syndrome when previous treatments have failed. We have recently systematically evaluated the immediate outcome and the long-term consequences of BADx in Cushing's syndrome (3) and reported our results in 36 patients treated with BADx in Munich (4). The present review addresses the practical aspects of BADx and is based on recent evidence and the outcome of 53 BADx treatments in our institution.…”

Section: Introductionmentioning

confidence: 99%

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A critical reappraisal of bilateral adrenalectomy for ACTH-dependent Cushing's syndrome

Reincke

Ritzel

Oßwald

et al. 2015

European Journal of Endocrinology

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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. Conclusion: BADx is a relatively safe and highly effective treatment, and it provides adequate control of long-term co-morbidities associated with hypercortisolism.European Journal of Endocrinology (2015) 173, M23-M32 Invited Author's profile Prof. Martin Heinrich Reincke is Director of the Medizinische Klinik and Poliklinik IV, Ludwig-MaximiliansUniversität München, and Chair of the Department of Endocrinology and Diabetology. His research specialities include adrenal physiology and pathophysiology, endocrine hypertension, pituitary disease, mineralocorticoid and glucocorticoid action and stress research. Professor Reincke heads a research team that specifically explores the prevalence and relevance of Cushing's syndrome at the epidemiological, clinical, genetic and molecular levels. The research teams of his clinic have particular expertise in assay development and validation for endocrine disease and in the development of genetically manipulated animals as models for human adrenal disease.

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Section: Clinical Outcomes and Complicationsmentioning

confidence: 83%

Section: When Is Badx In Acth-dependent Cushing's Syndrome Indicated?mentioning

confidence: 99%

Section: Surgical Outcomementioning

confidence: 99%

Section: Clinical Outcomes and Complicationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A critical reappraisal of bilateral adrenalectomy for ACTH-dependent Cushing's syndrome

Reincke

Ritzel

Oßwald

et al. 2015

European Journal of Endocrinology

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American Association of Endocrine Surgeons Guidelines for Adrenalectomy

et al. 2022

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ImportanceAdrenalectomy is the definitive treatment for multiple adrenal abnormalities. Advances in technology and genomics and an improved understanding of adrenal pathophysiology have altered operative techniques and indications.ObjectiveTo develop evidence-based recommendations to enhance the appropriate, safe, and effective approaches to adrenalectomy.Evidence ReviewA multidisciplinary panel identified and investigated 7 categories of relevant clinical concern to practicing surgeons. Questions were structured in the framework Population, Intervention/Exposure, Comparison, and Outcome, and a guided review of medical literature from PubMed and/or Embase from 1980 to 2021 was performed. Recommendations were developed using Grading of Recommendations, Assessment, Development and Evaluation methodology and were discussed until consensus, and patient advocacy representation was included.FindingsPatients with an adrenal incidentaloma 1 cm or larger should undergo biochemical testing and further imaging characterization. Adrenal protocol computed tomography (CT) should be used to stratify malignancy risk and concern for pheochromocytoma. Routine scheduled follow-up of a nonfunctional adrenal nodule with benign imaging characteristics and unenhanced CT with Hounsfield units less than 10 is not suggested. When unilateral disease is present, laparoscopic adrenalectomy is recommended for patients with primary aldosteronism or autonomous cortisol secretion. Patients with clinical and radiographic findings consistent with adrenocortical carcinoma should be treated at high-volume multidisciplinary centers to optimize outcomes, including, when possible, a complete R0 resection without tumor disruption, which may require en bloc radical resection. Selective or nonselective α blockade can be used to safely prepare patients for surgical resection of paraganglioma/pheochromocytoma. Empirical perioperative glucocorticoid replacement therapy is indicated for patients with overt Cushing syndrome, but for patients with mild autonomous cortisol secretion, postoperative day 1 morning cortisol or cosyntropin stimulation testing can be used to determine the need for glucocorticoid replacement therapy. When patient and tumor variables are appropriate, we recommend minimally invasive adrenalectomy over open adrenalectomy because of improved perioperative morbidity. Minimally invasive adrenalectomy can be achieved either via a retroperitoneal or transperitoneal approach depending on surgeon expertise, as well as tumor and patient characteristics.Conclusions and RelevanceTwenty-six clinically relevant and evidence-based recommendations are provided to assist surgeons with perioperative adrenal care.

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Neoplasms of the Endocrine Glands: Pituitary Neoplasms

Gandhi

Post

2017

Holland‐Frei Cancer Medicine

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Overview Pituitary neoplasms represent a phenotypically and pathologically diverse family of tumors. Treatment and classification are both patient and tumor specific as symptoms may derive from abnormal hormone production, compression of adjacent nervous system structures, and, in rare cases, metastases. Transsphenoidal surgery represents a common and well‐tolerated treatment for most pituitary adenomas; however, advances in radiation and chemotherapy have increased treatment options, enhancing treatment efficacy, and eligibility.

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Favorable long-term outcomes of bilateral adrenalectomy in Cushing's disease

Cited by 77 publications

References 22 publications

A critical reappraisal of bilateral adrenalectomy for ACTH-dependent Cushing's syndrome

A critical reappraisal of bilateral adrenalectomy for ACTH-dependent Cushing's syndrome

American Association of Endocrine Surgeons Guidelines for Adrenalectomy

Neoplasms of the Endocrine Glands: Pituitary Neoplasms

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