Skip to main content

Advertisement

SpringerLink
Log in

Cushing’s disease: role of bilateral adrenalectomy

  • Published:
Pituitary Aims and scope Submit manuscript

Abstract

Introduction

Laparoscopic bilateral adrenalectomy (BAD) is one of the treatments of Cushing’s Disease (CD), but its indications and outcome is debated.

Methods

The literature on BAD was reviewed as part of a work performed for the Cushing’s disease guideline.

Results

The surgical morbidity of BAD is reported between 10 and 18% and no mortality has been reported in the largest series. Because of the endocrine sacrifice it will be mostly performed after a multidisciplinary team discussion in selected cases of refractory CD (mostly after failure of pituitary surgery and/or medical treatment). It is also frequently discussed in female patients desiring pregnancy. Corticotroph tumor progression occurs in 40% of the patients but is in most patients manageable when detected early by a careful long term monitoring with pituitary MRI and ACTH assays after BAD.

Conclusion

BAD is a safe and effective treatment of CD used in specific situations and requiring long term monitoring.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Fleseriu M, Auchus R, Bancos I, Ben-Shlomo A, Bertherat J, Biermasz NR, Boguszewski CL, Bronstein MD, Buchfelder M, Carmichael JD, Casanueva FF, Castinetti F, Chanson P, Findling J, Gadelha M, Geer EB, Giustina A, Grossman A, Gurnell M, Ho K, Ioachimescu AG, Kaiser UB, Karavitaki N, Katznelson L, Kelly DF, Lacroix A, McCormack A, Melmed S, Molitch M, Mortini P, Newell-Price J, Nieman L, Pereira AM, Petersenn S, Pivonello R, Raff H, Reincke M, Salvatori R, Scaroni C, Shimon I, Stratakis CA, Swearingen B, Tabarin A, Takahashi Y, Theodoropoulou M, Tsagarakis S, Valassi E, Varlamov EV, Vila G, Wass J, Webb SM, Zatelli MC, Biller BMK (2021) Consensus on diagnosis and management of Cushing’s disease: a guideline update. Lancet Diabetes Endocrinol 9(12):847–875. https://doi.org/10.1016/S2213-8587(21)00235-7

    Article  PubMed  Google Scholar 

  2. Oßwald A, Plomer E, Dimopoulou C, Milian M, Blaser R, Ritzel K, Mickisch A, Knerr F, Stanojevic M, Hallfeldt K, Schopohl J, Kuhn KA, Stalla G, Beuschlein F, Reincke M (2014) Favorable long-term outcomes of bilateral adrenalectomy in Cushing’s disease. Eur J Endocrinol 171(2):209–215. https://doi.org/10.1530/EJE-14-0214

    Article  CAS  PubMed  Google Scholar 

  3. Guerin C, Taieb D, Treglia G, Brue T, Lacroix A, Sebag F, Castinetti F (2016) Bilateral adrenalectomy in the 21st century: when to use it for hypercortisolism? Endocr Relat Cancer 23(2):R131–R142. https://doi.org/10.1530/ERC-15-0541

    Article  CAS  PubMed  Google Scholar 

  4. Ritzel K, Beuschlein F, Mickisch A, Osswald A, Schneider HJ, Schopohl J, Reincke M (2013) Clinical review: outcome of bilateral adrenalectomy in Cushing’s syndrome: a systematic review. J Clin Endocrinol Metab. 98(10):3939–3948. https://doi.org/10.1210/jc.2013-1470

    Article  CAS  PubMed  Google Scholar 

  5. Chow JT, Thompson GB, Grant CS, Farley DR, Richards ML, Young WF Jr (2008) Bilateral laparoscopic adrenalectomy for corticotrophin-dependent Cushing’s syndrome: a review of the Mayo Clinic experience. Clin Endocrinol (Oxf) 68(4):513–519. https://doi.org/10.1111/j.1365-2265.2007.03082.x

    Article  Google Scholar 

  6. Smith PW, Turza KC, Carter CO, Vance ML, Laws ER, Hanks JB (2009) Bilateral adrenalectomy for refractory Cushing disease: a safe and definitive therapy. J Am Coll Surg 208(6):1059–1064. https://doi.org/10.1016/j.jamcollsurg.2009.02.054

    Article  PubMed  Google Scholar 

  7. Thompson SK, Hayman AV, Ludlam WH, Deveney CW, Loriaux DL, Sheppard BC (2007) Improved quality of life after bilateral laparoscopic adrenalectomy for Cushing’s disease: a 10-year experience. Ann Surg 245(5):790–794. https://doi.org/10.1097/01.sla.0000251578.03883.2f

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hawn MT, Cook D, Deveney C, Sheppard BC (2002) Quality of life after laparoscopic bilateral adrenalectomy for Cushing’s disease. Surgery 132(6):1064–1068. https://doi.org/10.1067/msy.2002.128482

    Article  PubMed  Google Scholar 

  9. Takata MC, Kebebew E, Clark OH, Duh QY (2008) Laparoscopic bilateral adrenalectomy: results for 30 consecutive cases. Surg Endosc. 22(1):202–207. https://doi.org/10.1007/s00464-007-9478-3

    Article  CAS  PubMed  Google Scholar 

  10. Reincke M, Ritzel K, Oßwald A, Berr C, Stalla G, Hallfeldt K, Reisch N, Schopohl J, Beuschlein F (2015) A critical reappraisal of bilateral adrenalectomy for ACTH-dependent Cushing’s syndrome. Eur J Endocrinol 173(4):M23-32. https://doi.org/10.1530/EJE-15-0265

    Article  CAS  PubMed  Google Scholar 

  11. Assié G, Bahurel H, Coste J, Silvera S, Kujas M, Dugué MA, Karray F, Dousset B, Bertherat J, Legmann P, Bertagna X (2007) Corticotroph tumor progression after adrenalectomy in Cushing’s Disease: a reappraisal of Nelson’s syndrome. J Clin Endocrinol Metab. 92(1):172–179. https://doi.org/10.1210/jc.2006-1328

    Article  CAS  PubMed  Google Scholar 

  12. Reincke M, Albani A, Assie G, Bancos I, Brue T, Buchfelder M, Chabre O, Ceccato F, Daniele A, Detomas M, Di Dalmazi G, Elenkova A, Findling J, Grossman AB, Gomez-Sanchez CE, Heaney AP, Honegger J, Karavitaki N, Lacroix A, Laws ER, Losa M, Murakami M, Newell-Price J, PecoriGiraldi F, Pérez-Rivas LG, Pivonello R, Rainey WE, Sbiera S, Schopohl J, Stratakis CA, Theodoropoulou M, van Rossum EFC, Valassi E, Zacharieva S, Rubinstein G, Ritzel K (2021) Corticotroph tumor progression after bilateral adrenalectomy (Nelson’s syndrome): systematic review and expert consensus recommendations. Eur J Endocrinol. 184(3):P1–P16. https://doi.org/10.1530/EJE-20-1088

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Fountas A, Lim ES, Drake WM, Powlson AS, Gurnell M, Martin NM, Seejore K, Murray RD, MacFarlane J, Ahluwalia R, Swords F, Ashraf M, Pal A, Chong Z, Freel M, Balafshan T, Purewal TS, Speak RG, Newell-Price J, Higham CE, Hussein Z, Baldeweg SE, Dales J, Reddy N, Levy MJ, Karavitaki N (2020) Outcomes of patients with Nelson’s syndrome after primary treatment: a multicenter study from 13 UK Pituitary Centers. J Clin Endocrinol Metab. 105(5):1527. https://doi.org/10.1210/clinem/dgz200

    Article  Google Scholar 

  14. Jornayvaz FR, Assie G, Bienvenu-Perrard M, Coste J, Guignat L, Bertherat J, Silvera S, Bertagna X, Legmann P (2011) Pregnancy does not accelerate corticotroph tumor progression in Nelson’s syndrome. J Clin Endocrinol Metab 96(4):E658–E662. https://doi.org/10.1210/jc.2010-2235

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

No funding was received to assist with the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Endocrinology Department, Center for Rare Adrenal Diseases, Cochin Hospital, AP-HP, Université Paris Cité, 75014, Paris, France

    Jérôme Bertherat

Authors
  1. Jérôme Bertherat
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JB did the review on this topic as part of a work performed for the Cushing's disease guideline and wrote the manuscript and the table

Corresponding author

Correspondence to Jérôme Bertherat.

Ethics declarations

Competing interests

The authors have no competing interests to declare that are relevant to the content of this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bertherat, J. Cushing’s disease: role of bilateral adrenalectomy. Pituitary 25, 743–745 (2022). https://doi.org/10.1007/s11102-022-01260-w

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11102-022-01260-w

Keywords

Search

Navigation