Management of acute hypercortisolism

Thompson, Norman W.; Allo, Maria D.

doi:10.1007/bf01655367

Cited by 4 publications

(2 citation statements)

References 41 publications

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“…In conjunction with adrenal blockade a remission rate of 53', was reported (Ross et al. 1979), and this has the advantage that hypercortisolism can be controlled during the lag period which can be as long as 18 months (Thompson & Allo. 1982).…”

mentioning

confidence: 99%

Pituitary Function Following Megavoltage Therapy for Cushing's Disease: Long Term Follow Up

Sharpe

Kendall‐Taylor

Prescott

et al. 1985

Clinical Endocrinology

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Eight patients who had received megavoltage therapy for Cushing's disease 5-12 years previously have been reviewed. The long term response to this therapy was assessed with respect to efficacy of treatment in inducing continued remission and disturbance of hypothalamic-pituitary function. One patient showed clear evidence of relapse of Cushing's disease. One patient had unequivocal hypopituitarism. Basal levels of growth hormone (GH), TSH, LH, and FSH were not statistically different from controls, but provocative testing revealed significant abnormalities of response of cortisol/ACTH, GH, prolactin and LH. Six out of eight patients had absent diurnal cortisol variation and five patients had elevated serum prolactin levels. Thus, in this group of patients normal pituitary-adrenal function has not been satisfactorily restored. It is clear that significant disturbances of hypothalamic-pituitary function follow mega-voltage therapy and these may progress to overt hypopituitarism.

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mentioning

confidence: 99%

Pituitary Function Following Megavoltage Therapy for Cushing's Disease: Long Term Follow Up

Sharpe

Kendall‐Taylor

Prescott

et al. 1985

Clinical Endocrinology

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“…Bilateral adrenalectomy assumes a well defined role in the treatment of Cushing's disease [25,26]: (1) in cases in which pituitary treatment has been unsuccessful; or (2) pituitary surgery is a technical impossibility; and (3) in the presence of a rapidly worsening syndrome of hypercortisolism that cannot be adequately controlled with drug therapy because the latter is not tolerated by the patient and for which a clear-cut diagnosis cannot be made [27]. Once the need for operation has been established, the patient must follow a precise preoperative treatment with the aim of both restricting cortisol secretion and correcting its effects.…”

Section: Discussionmentioning

confidence: 99%

Role of bilateral adrenalectomy in Cushing's disease

Favia¹,

Boscaro²,

Lumachi³

et al. 1994

World j. surg.

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Of 206 patients with Cushing's syndrome observed from 1975 through 1991, 144 (69.9%) had pituitary-dependent Cushing's disease. Of the 110 patients who underwent pituitary surgery, 31 (28%) developed an early recurrence and 23 patients (20%) had a late relapse 1 to 5 years after primary pituitary exploration. We performed a one- or two-step total bilateral adrenalectomy in 43 patients-9 men and 34 (79.4%) women, with an average age of 47.5 years (range 13-58 years). Thirty-three of these patients had already been treated by previous transsphenoidal surgery or alternatively by external pituitary irradiation over a period of 1 to 10 years prior to adrenal surgery. Thirty-one patients underwent adrenalectomy by a double lumbar access or left lumbar and right subcostal incisions. In our series of 55 operations, perioperative complications included two splenectomies and two hemorrhages (7.3%). The early mortality rate was 3.6% (two patients). Minor complications consisted of wound infection (13.5%), bronchopneumonia or pneumothorax (four cases) with a 7- to 12-day longer hospital stay. Nelson syndrome occurred in 6 of 41 patients (14.6%). We therefore believe that bilateral adrenalectomy does play a major role in the treatment of patients with pituitary-dependent Cushing's disease unsuccessfully managed by transphenoidal surgery. It represents the definitive therapy for those patients in whom hypophysectomy was not able to provide satisfactory control of the disease.

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