Laparoscopic Bilateral Partial Adrenalectomy for Adrenocortical Adenomas Causing Cushing's Syndrome: Report of a Case

Abstract

Laparoscopic total adrenalectomy has become a standard technique for small adrenal tumors; however, bilateral adrenalectomy results in postoperative adrenal insufficiency, necessitating lifelong steroid replacement. To preserve adrenocortical function in a 41-year-old woman with bilateral adrenocortical adenoma (BAA) causing Cushing's syndrome, we performed laparoscopic bilateral partial adrenalectomy. We based our preoperative diagnosis of bilateral adrenocortical tumors causing Cushing's syndrome on the results of endocrinological investigations and imaging findings. Thus, we performed lateral transperitoneal laparoscopic bilateral partial adrenalectomy, preserving the adrenal glands, which were normal. Pathological examination of both tumors confirmed the diagnosis of adrenocortical adenoma. The patient had no postoperative complications, and her adrenocortical function was normal without steroid replacement at her 10-month follow-up. This report shows that Cushing's syndrome resulting from bilateral adenomas can be effectively treated by laparoscopic bilateral partial adrenalectomy as a minimally invasive, adrenocortical-preserving operation.

Laparoscopic bilateral adrenalectomy: results for 30 consecutive cases

“…To avoid the short-and long-term metabolic and hormonal complications associated with removal of both adrenal glands, laparoscopic partial adrenalectomy has been described for bilateral pheochromocytoma [24][25][26][27] and Cushing's syndrome caused by bilateral adenomas [28]. Partial adrenalectomy increases the risk of pheochromocytoma recurrence and is inappropriate for patients with ACTH-dependent bilateral cortical hyperplasia.…”

Laparoscopic simultaneous bilateral partial and total adrenalectomy: a longer follow‐up

“…Inoue et al. [20] reported LSB PA in a 41‐year‐old woman, with no postoperative complications, and her adrenocortical function was normal with no steroid replacement at her 10‐month follow‐up. Domino et al.…”

“…However, there are fewer reports about LSB PAs for bilateral adrenal tumours, and most cases reported were phaeochromocytomas [14,15,18,19]. LSB PAs for bilateral functioning adenomas causing primary aldosteronism [17] or Cushing's syndrome [15,[19][20][21] were more scant. Here, we report our experience of LSBAS, and further compare the results between TA and PA. To our knowledge, this is the largest series of LSB PAs for bilateral adrenal tumours other than phaeochromocytomas.…”

Unusual causes of Cushing's syndrome

“…A female predominance was observed (91%) and also the size of the adenomas was a little smaller than that reported for solitary adenomas, with a mean size of 2.6 cm. Three additional cases were reported hitherto (40)(41)(42); in one patient the two adenomas developed at different periods 9 year apart (42). The imaging characteristics of bilateral adenomas are quite different from those of PPNAD and AIMAH.…”