Long‐term Results of Adrenal Surgery in Patients With Cushing's Syndrome Due to Adrenocortical Adenoma

Abstract

Fourteen of 16 patients with Cushing's syndrome due to adrenal adenoma who had undergone adrenal surgery in the period 1967-1981 participated in a follow-up study 1 to 15 (mean 4.5) years after the operation. There were 14 unilateral and two bilateral adenomas. Two patients have died: one from postoperative complications, the other by suicide 10 years after surgery. None of the patients relapsed and none showed clinical features of Cushing's syndrome. However, five patients remained obese and four hypertensive. Furthermore, in the female patients the bone mineral density was lower than in age-matched controls. The function of the pituitary-adrenal axis recovered slowly. Postoperative replacement therapy was withdrawn 3 to 28 (mean 11.8) months after surgery in all but one patient. The function of the remaining adrenal gland was completely normal in 10 patients. In two patients the plasma cortisol response to ACTH-stimulation was still blunted and associated with elevated plasma ACTH-levels. The plasma ACTH-level was low in the only patient having persistent hypocortisolism. In conclusion, the results show that most patients with Cushing's syndrome due to adrenal adenoma recover fully after surgery. In some patients, however, the suppressed pituitary and/or adrenal fail to resume normal function.

Characteristics of recovery of adrenocortical function after treatment for Cushing's syndrome due to pituitary or adrenal adenomas

“…Our data show that patients surgically cured from AA had a significant increase in p‐ACTH to the upper part of the normal range (or even higher) prior to recovery, whereas p‐ACTH remained suppressed in patients not recovering, illustrating that recovery of adrenocortical function lags behind recovery of the hypothalamic–pituitary function in patients with AA. These data are in accordance with early studies performed in patients withdrawn from either endogenous hypercorticism after excision of a cortisol‐producing adrenal adenoma or exogenous hypercorticism due to prolonged glucocorticoid treatment (Graber et al ., 1965; Valimaki et al ., 1984).…”

“…Median time to recovery was 2 years, whereas 20 -30% had not yet recovered after observation for 3 -12 years. This time course is slightly slower than that observed by others ( Fitzgerald et al ., 1982;Valimaki et al ., 1984;Doherty et al ., 1990;Rees et al ., 2002) despite tapering hydrocortisone to the smallest dose not eliciting symptoms of adrenal insufficiency (i.e. less than 30 mg /day).…”

A study of hypothalamic-pituitary-adrenal suppression following curative surgery for Cushing's syndrome due to adrenal adenoma

“….1;Wel- bourn et al 1971;Hardy 1978;Welbourn 1980;Bertagna & Orth 1981;Skalkeas et al 1982;Valimaki et al 1984). However, prolonged sup¬ pression of the hypothalamic-pituitary-adrenal axis occurs in a minority of patients in whom we have demonstrated defects at various levels within the axis.…”

“…Although most patients eventually achieve recovery of adrenal function, series reporting the long-term results of adrenal surgery often include a small number of patients in whom prolonged follow-up fails to demon¬ strate such recovery (Welbourn et al 1971;Valimaki et al 1984). The mechanisms resulting in continued suppression of adrenocortical activity in these patients are little understood.…”

Adrenostatische Therapie mit Metyrapon und Aminoglutethimid beim ACTH-abhängigen Cushing-Syndrom

“…Beim Nebennierenadenom bzw. -karzinom wird die operative Entfernung des Tumors angestrebt (15). Das ektope Cushing-Syndrom ist dagegen aufgrund des meist fortgeschrittenen Grundleidens einer kurativen Therapie selten zugänglich, obwohl in günstigen Fällen eine komplette Resektion des ACTH-bildenden Tumors zu dauerhafter Heilung führen kann (5).…”