Surgical Treatment of Adrenocortical Hyperplasia: 20-year Experience

Bennett, Alan H.; Cain, John P.; Dluhy, Robert G.; Tynes, William V.; Harrison, J. Hartwell; Thorn, George W.

doi:10.1016/s0022-5347(17)60417-8

Cited by 17 publications

(7 citation statements)

References 7 publications

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“…The prevalence of Nelson's syndrome ranges from 8 to 29% in the largest series with more than 40 patients [2,30,[34][35][36][37][38][39][40][41][42][43], with a time interval between adrenalectomy and the diagnosis of Nelson's syndrome ranging from 0.5 to 24 years. Patients were included between the middle of the fifties until the end of the nineties, with an inclusion time ranging from 9 to 36 years.…”

Section: Prevalencementioning

confidence: 99%

The Nelson's syndrome... revisited

et al. 2004

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Adrenalectomy is a radical therapeutic approach to control hypercortisolism in some patients with Cushing's disease. However it may be complicated by the Nelson's syndrome, defined by the association of a pituitary macroadenoma and high ACTH secretion after adrenalectomy. This definition has not changed since the end of the fifties. Today the Nelson's syndrome must be revisited with new to criteria using more sensitive diagnostic tools, especially the pituitary magnetic resonance imaging. In this paper we will review the pathophysiological aspects of corticotroph tumor growth, with reference to the impact of adrenalectomy. The main epidemiological data on the Nelson's syndrome will be presented. More importantly, we will propose a new pathophysiological and practical approach to this question which attempts to evaluate the Corticotroph Tumor Progression after adrenalectomy, rather than to diagnose the Nelson's syndrome. We will discuss the consequences for the management of Cushing's disease patients after adrenalectomy, and will also draw some perspectives.

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Section: Prevalencementioning

confidence: 99%

The Nelson's syndrome... revisited

et al. 2004

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“…Bilateral adrenalectomy still has the obvious attraction of rapidly and reliably reversing hypercortisolism (Orth & Liddle, 1971;Welbourn et al, 1971;Kelly et al, 1983). A number of early reports, however, noted significant mortality (Sprague e f al., 1953;1961;Montgomery & Welbourn, 1957;Welbourn et al, 1971;Ernest & Ekman, 1972;Bennett et al, 1973;Scott et al, 1977) and a high incidence of postoperative complications (Beck et al, 1954;Welbourne et al, 1971;Scott et al, 1977). The patient is left with permanent glucocorticoid and mineralocorticoid deficiency and there is also the rare possibility of recurrence following the operation (Chalmers et al, I98 1).…”

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confidence: 99%

Bilateral adrenalectomy: low mortality and morbidity in Cushing's disease

McCance¹,

Russell

Kennedy

et al. 1993

Clinical Endocrinology

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“…The clinical features of the disease are secondary to chronic hypercortisolism, and pituitary ACTH overproduction is responsible for adrenal hypersecretion (2). For years treatment of Cushing's disease was directed toward the adrenals, using either surgical or pharmacological means (3,4). Although effective in controlling hypercortisolism, these therapeutic approaches could not restore normal pituitary-adrenal function, and the occurrence of pituitary macroadenomas in some patients after bilateral adrenalectomy (5) reawakened interest in the importance of the pituitary in the pathophysiology of the disease.…”

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confidence: 99%

Transsphenoidal Pituitary Surgery for the Treatment of Cushing' s Disease: Results in 64 Patients and Long Term Follow-Up Studies*

Guilhaume

Bertagna

Thomsen

et al. 1988

The Journal of Clinical Endocrinology & Metabolism

143

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Transsphenoidal pituitary surgery was performed in 64 patients with Cushing's disease in search of a corticotroph adenoma. In 4 patients, profuse local bleeding prevented completion of the exploration. Of the 60 patients who had an adequate exploration, 4 could not be followed after surgery. Short term assessment of the surgical outcome (3-6 months postoperatively) was performed on 60 patients, including the 4 who had incomplete pituitary exploration. Forty-two patients (70%) were judged as immediate successes [urinary cortisol excretion, less than 90 micrograms (less than 248 nmol)/day]; the mean urinary cortisol excretion and plasma ACTH level fell from 463 +/- 70 (+/- SE) to 26.7 +/- 3.6 micrograms/day (1277 +/- 193 to 74 +/- 10 nmol/day; n = 33) and from 111 +/- 33 to 36 +/- 14 pg/mL (24 +/- 7 to 8 +/- 3 pmol/L; n = 23) in patients who had both measurements pre- and postoperatively. Eighteen patients (30%) were judged as immediate failures; neither urinary cortisol excretion nor plasma ACTH levels changed significantly in patients who had both measurements pre- and postoperatively. The preoperative epidemiological, clinical, hormonal, and radiological characteristics of the 2 groups were similar. Histological examination of pituitary fragments removed in 58 of the 60 patients evaluated postoperatively revealed the presence of tumoral tissue in a higher percentage of patients in the immediate success group (72%) than in the immediate failure group (24%; P less than 0.01). The 42 patients in the immediate success group were followed from 6 months to 7 yr (median, 2 yr); 6 patients had recurrences from 2-3 yr after operation. Actuarial analysis indicates that the probability of a patient remaining well 6 yr after surgery is 72 +/- 20% (95% confidence limit). Most of the patients in the immediate success group had transient ACTH deficiency preceding a progressive return to normal pituitary-adrenal function.

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Surgical Treatment of Adrenocortical Hyperplasia: 20-year Experience

Cited by 17 publications

References 7 publications

The Nelson's syndrome... revisited

The Nelson's syndrome... revisited

Bilateral adrenalectomy: low mortality and morbidity in Cushing's disease

Transsphenoidal Pituitary Surgery for the Treatment of Cushing' s Disease: Results in 64 Patients and Long Term Follow-Up Studies*

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