ADRENALECTOMY IN CUSHING'S SYNDROME PATIENTS

AUTHORS:
H. Markogiannakis (Athens, Greece) , A.S. Zambopoulou (Athens, Greece) , T. Hatzitheodorou (Athens, Greece) , A. Hatzicharalambous (Athens, Greece) , M. Kalamatianou (Athens, Greece) , N. Intzes (Athens, Greece) , E. Kitsou (Athens, Greece) , I. Manouras (Athens, Greece) , K.G. Toutouzas (Athens, Greece) , D. Theodorou (Athens, Greece)
Background:
The objective of this study was to analyze the results of adrenalectomy in patients with Cushing's syndrome.
Methods:
This is a prospective study of all adrenalectomies for Cushing's syndrome performed in our department during the period 1/1/2010-31/12/2022.
Results:
Among 179 adrenalectomies, 28 (15.6%) had Cushing's syndrome and composed our study group (mean age: 54.9±4.7 years, female: 67.8%). Three cases (10.7%) suffered from refractory ectopic ACTH-dependent syndrome, two of whom underwent laparoscopic bilateral adrenalectomy. The remaining 25 (89.3%) presented with unilateral non-ACTH-dependent syndrome. Eight of the unilateral cases (32%) had subclinical Cushing's syndrome. Eleven procedures (42.3%) were right and 15 (57.7%) left adrenalectomies. Tumor mean diameter was 4.5±0.8 cm (range: 2-9 cm) and adrenal gland diameter was 6.1±0.9 cm (range: 3.3-11 cm). Operative time was 110.7±11.6 min. Laparoscopic adrenalectomy was performed in 22 (78.7%), open in 2 (7.1%) and in 4 (14.2%) conversion to open surgery was required. Postoperative complications were noted in 5 patients (17.8%): wound infection, wound hematoma, trocar site postoperative hernia, evisceration, pancreatic fistula, splenic and renal infarct. Mean postoperative hospital stay was 3.7±0.5 days. During the short follow-up period (mean value: 7±0.7 years) no syndrome recurrence has been noticed.
Conclusions:
Adrenalectomy in patients with Cushing's syndrome requires increased awareness during the whole perioperative period. In the majority of cases it can be performed laparoscopically with safety and effectiveness.