Surgical and functional outcomes of bilateral synchronous adrenalectomy for functional tumors: A cohort study

Bilateral synchronous adrenalectomy has the potential for significant surgical and functional morbidity. We reviewed our 15-year experience with bilateral synchronous adrenalectomy to assess the safety, surgical outcomes, morbidity, and impact on health-related quality of life (QoL).

In an IRB-approved study, we reviewed our database of patients who underwent bilateral synchronous adrenalectomy for functional tumors between April 2008 and August 2022. Demographic profile, metabolic and radiological parameters, operative details, and complications were recorded. Follow-up was obtained either in-person or telephonically and analyzed for resolution of symptoms, QoL using the WHO-QoL BREF questionnaire, and complications of chronic steroid intake. Data were reported descriptively and compared between laparoscopic and open approaches.

During the study period, 337 adrenalectomies were performed, of which, 51 were bilateral and in 48 patients both the surgeries were performed synchronously. Thirty-three of these 48 patients had bilateral pheochromocytomas and 15 had Cushing's syndrome. Among patients with Cushing's syndrome, three had life-threatening symptoms requiring urgent bilateral surgery. Forty patients underwent transperitoneal laparoscopic surgery and 8 underwent open surgery. There were two intraoperative and 7 post-operative complications. Forty-three patients were available for follow-up. All had resolution of symptoms and body mass index (BMI) changes, and only two patients continued to receive one antihypertensive medication. Episodes of steroid deficiency occurred in 7 patients while steroid excess occurred in 3 patients. QoL was satisfactory in all the patients in all the domains.

Bilateral synchronous adrenalectomy is safe and feasible for functional adrenal tumors. It leads to symptom resolution with amelioration of hypertension and BMI changes with satisfactory overall QoL.