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Surgical experience with Cushing's disease

H W Scott, G W Liddle, J L Mulherin

    Annals of Surgery
    |May 1, 1977
    PubMed
    Summary
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    Pituitary irradiation effectively treated most Cushing's disease cases. Bilateral total adrenalectomy offered a cure for severe or resistant hypercortisolism, though it carried surgical risks.

    Area of Science:

    • Endocrinology
    • Neurosurgery

    Background:

    • Cushing's disease, a form of hypercortisolism, presents significant clinical challenges.
    • Treatment strategies have evolved, balancing efficacy with patient safety.

    Purpose of the Study:

    • To evaluate the long-term outcomes of pituitary irradiation and bilateral total adrenalectomy for Cushing's disease.
    • To assess the effectiveness and safety of different treatment modalities over a 24-year period.

    Main Methods:

    • Retrospective analysis of 119 patients with Cushing's disease treated between 1952 and 1976.
    • Categorization of treatment based on disease severity: pituitary irradiation for less severe cases, adrenalectomy for severe or refractory cases.

    Main Results:

    • Two-thirds of patients treated with pituitary irradiation achieved endocrinologic cure or improvement.

    Related Experiment Videos

  • Bilateral total adrenalectomy resulted in endocrinologic cure in 24 of 29 patients, with one postoperative death and two requiring further management for hypercortisolism.
  • Nelson's syndrome occurred in one patient post-adrenalectomy, successfully managed with radiation therapy.

    • Conclusions:

    • Pituitary irradiation is a primary treatment for many Cushing's disease patients.
    • Bilateral total adrenalectomy is a viable and effective option for severe or treatment-resistant Cushing's disease, despite associated risks.
    • Long-term follow-up is crucial for managing potential complications such as Nelson's syndrome.