Bilateral adrenalectomy for Cushing's disease

Area of Science:

• Endocrinology
• Surgical Oncology
• Internal Medicine

Background:

• Cushing's disease (CD) is a rare endocrine disorder caused by excess cortisol production.
• Primary treatment for CD is pituitary surgery, but recurrence or persistent disease necessitates alternative management.
• Medical and radiation therapies are typically considered adjuvant to surgical interventions.

Purpose of the Study:

• To review the indications for bilateral adrenalectomy (BLA) in Cushing's disease.
• To analyze the outcomes and consequences of BLA in patients with persistent CD.
• To evaluate BLA's role in the management of refractory hypercortisolism.

Main Methods:

• A comprehensive literature review was conducted.
• Studies focusing on BLA for Cushing's disease were systematically analyzed.
• Data on indications, surgical approaches, outcomes, and complications were extracted.

Main Results:

• BLA is indicated for persistent CD after pituitary surgery or when rapid cortisol normalization is crucial.
• Laparoscopic BLA offers reduced morbidity compared to open procedures.
• While BLA carries risks of adrenal crisis and Nelson's syndrome, it effectively resolves CS symptoms and enhances long-term quality of life.

Conclusions:

• BLA is a viable treatment option for persistent Cushing's disease post-pituitary surgery.
• Consideration for BLA is particularly important in patients with severe hypercortisolism or those desiring pregnancy.
• BLA should be integrated into the treatment algorithm for refractory Cushing's disease.