Bilateral Adrenalectomy: Differences between Cushing Disease and Ectopic ACTH-Producing Tumors

Area of Science:

• Endocrinology and Metabolic Diseases
• Surgical Oncology
• Neurosurgery

Background:

• Bilateral adrenalectomy (BA) serves as a curative treatment for hypercortisolism in patients with corticotropin (ACTH)-dependent Cushing syndrome.
• Indications for BA include refractory Cushing's disease (CD) post-pituitary surgery and unresectable ectopic ACTH-producing neoplasms (EA).

Purpose of the Study:

• To compare patient demographics, clinical presentation, surgical outcomes, and survival following bilateral adrenalectomy (BA) for Cushing's disease (CD) versus ectopic ACTH-producing neoplasms (EA).
• To evaluate the safety and efficacy of minimally invasive surgery (MIS) for BA in both CD and EA cohorts.

Main Methods:

• A retrospective review of 137 patients undergoing BA between 1995 and 2017 at a single center.
• Analysis of demographics, laboratory findings, intraoperative variables, postoperative outcomes, and survival rates.
• Comparison between patients with CD (n=83) and EA (n=54).

Main Results:

• Patients with EA presented with higher preoperative serum cortisol levels (63 ± 40 μg/dL) compared to CD patients (33 ± 19 μg/dL).
• Minimally invasive surgery (MIS) was utilized in the majority of patients (86% CD vs. 75% EA) with similar operative times, blood loss, and complication rates between groups.
• Five-year survival was significantly lower in the EA cohort (30%) compared to the CD cohort (80%).

Conclusions:

• While BA can be safely performed using MIS for both CD and EA with comparable morbidity, patients with EA exhibit significantly poorer long-term survival.
• EA patients are more likely to require intraoperative transfusions and postoperative intensive care compared to CD patients.