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Synchronous bilateral adrenalectomy in ACTH-dependent hypercortisolism: predictors, biomarkers and outcomes
S Chiloiro1, A Giampietro1, M Raffaelli2
1Pituitary Unit, Divisione di Endocrinologia, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, 00168, Roma, Italy.
Endocrine
|October 5, 2019
Summary
Synchronous bilateral adrenalectomy (SBA) effectively treats severe hypercortisolism. This study found SBA safe and improved patient health, though identifying optimal candidates requires further research.
Area of Science:
- Endocrinology
- Surgical Oncology
- Clinical Medicine
Background:
- Hypercortisolism necessitates timely management to prevent fatal emergencies.
- Synchronous bilateral adrenalectomy (SBA) is an effective treatment for hypercortisolism.
- Specific indications for SBA are not well-defined.
Purpose of the Study:
- To evaluate the outcomes of patients who underwent SBA.
- To identify biomarkers that predict the need for SBA.
Main Methods:
- A mono-centric, longitudinal study of 19 patients undergoing SBA for ACTH-dependent hypercortisolism.
- Comparison with control groups: 44 patients post-pituitary adenoma resection and 8 post-neuroendocrine tumor resection.
Main Results:
- No short- or long-term complications or hypercortisolism recurrence observed post-SBA.
- Significant improvements in metabolic, hypertensive, and bone health parameters.
- Younger age at diagnosis, longer active hypercortisolism duration, higher ACTH and cortisol levels, and higher Ki67 were associated with SBA patients compared to controls.
Conclusions:
- SBA is a safe and effective treatment for unmanageable ACTH-dependent hypercortisolism.
- Multidisciplinary team management in high-volume centers is recommended.
- Further research is needed for precise patient selection and surgical timing.
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