Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
World Journal of Surgery
Published in: World Journal of Surgery 5/2006

01-05-2006

Bilateral Adrenalectomy for Ectopic Cushing’s Syndrome—Discussions on Technique and Indication

Authors: Per Hellman, MD, PhD, Fredrik Linder, MD, Joakim Hennings, MD, Ola Hessman, MD, PhD, Barbro Eriksson, MD, PhD, Håkan Örlefors, MD, PhD, Göran Åkerström, MD, PhD

Published in: World Journal of Surgery | Issue 5/2006

Login to get access

Abstract

Background

Tumors producing adrenocorticotropic hormone (ACTH) or corticotropin releasing hormone (CRH) often remain undiagnosed until severe Cushing’s syndrome appears, and it may be difficult to distinguish from Cushing’s syndrome due to pituitary tumors. Many patients suffer from disease spread, with metastases in the liver or other locations, and the main symptoms may be mineral disturbances, diabetes mellitus, or psychological symptoms from the severe hypercortisolism. Bilateral adrenalectomy may alleviate this situation, but is sometimes a troublesome procedure in these severely ill patients.

Methods

We have retrospectively investigated 8 patients with ectopic Cushing’s syndrome who have undergone bilateral adrenalectomy at the University Hospital in Uppsala. In addition, another 5 patients who underwent bilateral adrenalectomy for other reasons (recurrent pituitary Mb Cushing or bilateral hyperplasia) were scrutinized for technical considerations. Indications, timing of surgery, and operative procedures were studied to identify signs that may support our approach to management in the future.

Results

Curative surgery was not possible in any of the cases with ectopic Cushing’s syndrome. Of the 13 operated patients, handport-assisted laparoscopic adrenalectomy was successfully performed bilaterally in 5 patients and unilaterally in combination with contralateral open surgery in 1 patient; conventional open surgery was performed on 7 patients, 3 of which were conversions from intitial handport-assisted procedures. Non-fatal complications occurred in 4 out of 10 patients.

Conclusions

We conclude that bilateral handport-assisted laparoscopic adrenalectomy is safe, and that all surgical techniques in these severely ill patients may be troublesome and technically demanding. Early surgical intervention may reduce the technical disadvantages. Moreover, bilateral adrenalectomy can substantially reduce the symptoms of Cushing’s syndrome, although effects on mortality are not obvious.
Literature
1.
Becker M, Aron D. Ectopic ACTH syndrome and CRH-mediated Cushing’s syndrome. Endocrinol Metab Clin North Am 1994;23:585–590PubMed
2.
Odell W. Ectopic ACTH secretion: a misnomer. Endocrinol Metab Clin North Am 1991;20:371–373PubMed
3.
Berenyi M, Singh G, Gloster E, et al. ACTH-producing pheochromocytoma. Arch Pathol Lab Med 1977;101:31–35PubMed
4.
Aniszewski J, Young W, Thompson G, et al. Cushing syndrome due to ectopic adrenocorticotropic hormone secretion. World J Surg 2001;25:934–940CrossRefPubMed
5.
Doppman J, Nieman L, Miller D, et al. Ectopic adrenocorticotropic hormone syndrome: localization studies of 30 cases. Cancer 1989;172:115–119
6.
Wajchenberg B, Mendonca B, Liberman B, et al. Ectopic ACTH syndrome. J Steroid Biochem Mol Biol 1995;53:139–145CrossRefPubMed
7.
Brunt LM, Doherty GM, Norton JA, et al. Laparoscopic adrenalectomy compared to open adrenalectomy for benign adrenal neoplasms. J Am Coll Surg 1996;183:1–10PubMed
8.
Dudley N, Harrison B. Comparison of open posterior versus transperitoneal laparoscopic adrenalectomy. Br J Surg 1999;86:656–660CrossRefPubMed
9.
Duncan JL 3rd, Fuhrman GM, Bolton JS, et al. Laparoscopic adrenalectomy is superior to an open approach to treat primary hyperaldosteronism. Am Surg 2000;66:932–935; discussion 935–936PubMed
10.
Schteingart D. Ectopic secretion of peptides of the proopiomelanocortin family. Endocrinol Metab Clin North Am 1991;20:453–456PubMed
11.
Oliver RL, Davis JR, White A. Characterisation of ACTH related peptides in ectopic Cushing’s syndrome. Pituitary 2003;6:119–126CrossRefPubMed
12.
Delisle L, Boyer M, Warr D, et al. Ectopic corticotropin syndrome and small-cell carcinoma of the lung: clinical features, outcome, and complications. Arch Intern Med 1993;153:746–752CrossRefPubMed
13.
Bennett I, Ray M. Hand-assisted laparoscopic adrenalectomy: an alternative minimal invasive surgical technique for the adrenal gland. Aust N Z J Surg 2002;72:801–805CrossRef
14.
Kitaoka F, Yanaga K, Okudaira S, et al. Successful left adrenalectomy for metastatic hepatocellular carcinoma using hand-assisted laparoscopic surgery: report of a case. Surg Today 2005;35:172–174CrossRefPubMed
15.
Perrotti M, Ankem M, Peterson S, et al. Laparoscopic bilateral adrenalectomy with the use of a single midline hand-assist port. J Soc Laparoendoc Surg 2003;7:273–275
16.
Foxius A, Ramboux A, Lefebvre Y, et al. Hazards of laparoscopic adrenalectomy for Conn’s adenoma: when enthusiasm turns to tragedy. Surg Endosc 1999;13:715–717CrossRefPubMed
17.
Iacconi P, Bendinelli C, Miccoli P, et al. A case of Cushing’s syndrome due to adrenocortical carcinoma with recurrence 19 months after laparsocopic adrenalectomy. J Urol 1999;161:1580–1584CrossRefPubMed
18.
Vshiyama T, Suzuki K, Kageyama S, et al. A case of Cushing’s syndrome due to adrenocortical carcinoma with recurrence 19 months after laparoscopic adrenalectomy. J Urol 1997;157:2239–2240CrossRef
Metadata
Title
Bilateral Adrenalectomy for Ectopic Cushing’s Syndrome—Discussions on Technique and Indication
Authors
Per Hellman, MD, PhD
Fredrik Linder, MD
Joakim Hennings, MD
Ola Hessman, MD, PhD
Barbro Eriksson, MD, PhD
Håkan Örlefors, MD, PhD
Göran Åkerström, MD, PhD
Publication date
01-05-2006
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 5/2006
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-005-0347-8

Other articles of this Issue 5/2006

World Journal of Surgery 5/2006 Go to the issue

OriginalPaper

Classical and Follicular Variant of Papillary Thyroid Carcinoma: A Comparative Study on Clinicopathologic Features and Long-term Outcome

OriginalPaper

Selective Use of Adrenal Venous Sampling in the Lateralization of Aldosterone-producing Adenomas

OriginalPaper

Thyroidectomy Using Monitored Local or Conventional General Anesthesia: An Analysis of Outpatient Surgery, Outcome and Cost in 1,194 Consecutive Cases

OriginalPaper

Does Familial Non-Medullary Thyroid Cancer Adversely Affect Survival?

OriginalPaper

Total Parathyroidectomy Without Autotransplantation for Renal Hyperparathyroidism: Experience with a qPTH-controlled Protocol

OriginalPaper

Hypocalcaemia and Parathyroid Hormone Assay Following Total Thyroidectomy: Predicting the Future