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Outcomes of Bilateral Adrenalectomy in Cushing's Syndrome
Lakshmi Nagendra1, Nisha Bhavani1, Praveen V Pavithran1
1Department of Endocrinology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Cochin, Kerala, India.
Context:
The literature on outcomes of bilateral adrenalectomy (BADx) in Cushing's syndrome (CS) is scant.
Aims:
The aim of this study is to analyze the short- and long-term outcomes of patients who underwent BADx and to compare the outcomes among different etiologies of CS.
Settings And Design:
This is a retrospective analysis of patients who underwent BADx for CS at our center between 2005 and 2018.
Materials And Methods:
In all, 33 patients were studied for clinical outcomes, survival rates, and long-term complications.
Statistical Analysis:
All analyses were performed with SPSS software (version 21.0).
Results:
The mean age at surgery was 39.33 ± 15.67 years. The primary etiology for CS was Cushing's disease (CD) in 42.42%, ectopic source in 36.36%, primary pigmented nodular adrenocortical disease (PPNAD) in 12.12%, and adrenocorticotrophin hormone-independent macronodular adrenal hyperplasia (AIMAH) in 9.09% of patients. The median follow-up time was 72.77 months. Improvement in hypertension and diabetes status after surgery was seen in 78% and 76.19% of patients, respectively. Proximal myopathy improved in 68% of patients. Nelson's syndrome and adrenal crisis were seen in 21.4% of patients each on long-term follow-up. Total mortality after BADx was 33.3%. Mortality in the first 30 days after surgery was seen in five patients (15.15%). Higher cortisol levels at presentation and age more than 40 years were predictors of mortality. Among the Cushing's subtypes, PPNAD had the best prognosis followed by CD. Perioperative Infections were a major cause of mortality.
Conclusion:
BADx is an effective treatment for CS especially in patients with PPNAD and CD but carries a significant mortality rate too.