Quality of life after laparoscopic bilateral adrenalectomy for Cushing's disease

Hawn, Mary T.; Cook, David M.; Deveney, Clifford W.; Sheppard, Brett C.

doi:10.1067/msy.2002.128482

Cited by 114 publications

(98 citation statements)

References 18 publications

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“…The presence of residual pituitary tumour following TSS for Cushing's disease (pre-TBA) has been shown to be predictive for the subsequent development of Nelson's syndrome post TBA in most studies (7,30,33,34). In one series, 30% of patients with residual tumour at TSS subsequently developed Nelson's syndrome compared with 26% in those patients without residual tumour post TSS (31).…”

Section: Radiological Evidence Of Residual Pituitary Tumour Prior To Tbamentioning

confidence: 99%

Nelson's syndrome

Barber

Adams²,

Ansorge³

et al. 2010

European Journal of Endocrinology

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Nelson's syndrome is a potentially life-threatening condition that does not infrequently develop following total bilateral adrenalectomy (TBA) for the treatment of Cushing's disease. In this review article, we discuss some controversial aspects of Nelson's syndrome including diagnosis, predictive factors, aetiology, pathology and management based on data from the existing literature and the experience of our own tertiary centre. Definitive diagnostic criteria for Nelson's syndrome are lacking. We argue in favour of a new set of criteria. We propose that Nelson's syndrome should be diagnosed in any patient with prior TBA for the treatment of Cushing's disease and with at least one of the following criteria: i) an expanding pituitary mass lesion compared with pre-TBA images; ii) an elevated 0800 h plasma level of ACTH (O500 ng/l) in addition to progressive elevations of ACTH (a rise of O30%) on at least three consecutive occasions. Regarding predictive factors for the development of Nelson's syndrome post TBA, current evidence favours the presence of residual pituitary tumour on magnetic resonance imaging (MRI) post transsphenoidal surgery (TSS); an aggressive subtype of corticotrophinoma (based on MRI growth rapidity and histology of TSS samples); lack of prophylactic neoadjuvant pituitary radiotherapy at the time of TBA and a rapid rise of ACTH levels in year 1 post TBA. Finally, more studies are needed to assess the efficacy of therapeutic strategies in Nelson's syndrome, including the alkylating agent, temozolomide, which holds promise as a novel and effective therapeutic agent in the treatment of associated aggressive corticotroph tumours. It is timely to review these controversies and to suggest guidelines for future audit.

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Section: Radiological Evidence Of Residual Pituitary Tumour Prior To Tbamentioning

confidence: 99%

Nelson's syndrome

Barber

Adams²,

Ansorge³

et al. 2010

European Journal of Endocrinology

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“…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%

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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“…It is more common in women in their third to fourth decades of life. 2,8 Mucocutaneus hyperpigmentation is usually obvious and is an important clinical manifestation. Bilateral adrenalectomy removes the inhibitory effect of adrenal cortisol on hypothalamic corticotropin-releasing hormone (CRH) secretion and pituitary ACTH secretion.…”

Section: Discussionmentioning

confidence: 99%

“…An elevated ACTH level, therefore, is the most consistent and reliable diagnostic feature. 2,9 Bitemporal hemianopsia, seen in 10 to 57% of patients, is due to compression of the optic chiasm. Invasion of the cavernous sinus, affecting the oculomotor, trochlear and abducens nerves, may present as diplopia.…”

Section: Discussionmentioning

confidence: 99%

“…1 Although the prevalence of NS after bilateral adrenalectomy varies between 8 to 29%, the procedure is not frequently performed. [2][3][4] In the United States, the annual rate of bilateral adrenalectomy for Cushing's syndrome (CS) was reported to be 0.32 per 100,000 hospital discharges in 2000. 5 Cushing's Syndrome is the clinical manifestation of chronic exposure to excessive glucocorticoids, either from an exogenous or an endogenous source.…”

Section: Introductionmentioning

confidence: 99%

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