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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2015

01-12-2015 | Endocrine Tumors

Long-Term Outcome of Bilateral Laparoscopic Adrenalectomy Measured by Disease-Specific Questionnaire in a Unique Group of Patients with Cushing’s Syndrome

Authors: Vladimir Neychev, MD, PhD, Seth M. Steinberg, PhD, Lily Yang, BS, Amit Mehta, MS III, Naris Nilubol, MD, FCAS, Margaret F. Keil, CRNP, Lynnette Nieman, MD, Constantine A. Stratakis, MD, DMSci, Electron Kebebew, MD, FACS

Published in: Annals of Surgical Oncology | Special Issue 3/2015

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Abstract

Background

Laparoscopic bilateral adrenalectomy (LBA) is recommended for patients with bilateral adrenal disease and occult or unresectable ectopic Cushing’s syndrome (CS). There are limited data on long-term outcomes after LBA, partly due to the lack of disease-specific tools for the measurement of impact on patients’ health and quality of life.

Methods

We used a disease-specific questionnaire covering all major clinicopathologic characteristics of CS. We compared the outcome from LBA to a control group of 60 patients who had thyroidectomy (matched for age, gender, and time of surgery, 2:1 control-to-CS).

Results

Twenty-eight patients (20 women and 8 men) underwent LBA for CS. Of them, 24 patients (86 %) provided responses to our questionnaire. Ninety-two percent of patients’ responses indicated a significant improvement of general Cushing’s physical features with complete resolution reported in 59 % of responses. Significant improvement of associated biochemical abnormalities and comorbidities was reported in 83 % of patients’ responses including complete reversal in 58 %. Significant improvement in emotional-behavioral symptoms was reported in 84 % of patients’ responses with complete recovery in 53 %. All patients expressed satisfaction with LBA and significant improvement in their general health and self-reported quality of life. All of the improvements after LBA were statistically significant compared with the control group.

Conclusions

Our disease-specific questionnaire enables a clearer understanding of the association between the clinical, metabolic, and emotional-behavioral features of CS, its treatment with LBA, and long-term impact on patient-reported quality of life. This disease-specific questionnaire may be useful for future studies in patients with CS.
Appendix
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Literature
1.
Nieman LK, Biller BM, Findling JW, Newell-Price J, Savage MO, Stewart PM, et al. The diagnosis of Cushing’s syndrome: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008;93(5):1526–40.PubMedPubMedCentralCrossRef
2.
Newell-Price J, Bertagna X, Grossman AB, Nieman LK. Cushing’s syndrome. Lancet. 2006;367(9522):1605–17.PubMedCrossRef
3.
Porterfield JR, Thompson GB, Young WF,Jr, Chow JT, Fryrear RS, van Heerden JA, et al. Surgery for Cushing’s syndrome: an historical review and recent ten-year experience. World J Surg. 2008;32(5):659–77.PubMedCrossRef
4.
Findling JW, Raff H. Cushing’s syndrome: important issues in diagnosis and management. J Clin Endocrinol Metab. 2006;91(10):3746–53.PubMedCrossRef
5.
Arnaldi G, Angeli A, Atkinson AB, Bertagna X, Cavagnini F, Chrousos GP, et al. Diagnosis and complications of Cushing’s syndrome: a consensus statement. J Clin Endocrinol Metab. 2003;88(12):5593–602.PubMedCrossRef
6.
Tritos NA, Biller BM, Swearingen B. Management of Cushing disease. Nat Rev Endocrinol. 2011;7(5):279–89.PubMedCrossRef
7.
Powell AC, Stratakis CA, Patronas NJ, Steinberg SM, Batista D, Alexander HR, et al. Operative management of cushing syndrome secondary to micronodular adrenal hyperplasia. Surgery. 2008;143(6):750–8.PubMedPubMedCentralCrossRef
8.
Lacroix A, Bourdeau I. Bilateral adrenal Cushing’s syndrome: macronodular adrenal hyperplasia and primary pigmented nodular adrenocortical disease. Endocrinol Metab Clin North Am. 2005;34(2):441–58.
9.
Mancini T, Porcelli T, Giustina A. Treatment of cushing disease: overview and recent findings. Ther Clin Risk Manag. 2010;6:505–16.PubMedPubMedCentral
10.
Hsiao HP, Kirschner LS, Bourdeau I, Keil MF, Boikos SA, Verma S, et al. Clinical and genetic heterogeneity, overlap with other tumor syndromes, and atypical glucocorticoid hormone secretion in adrenocorticotropin-independent macronodular adrenal hyperplasia compared with other adrenocortical tumors. J Clin Endocrinol Metab. 2009;94(8):2930–7.PubMedPubMedCentralCrossRef
11.
Ilias I, Torpy DJ, Pacak K, Mullen N, Wesley RA, Nieman LK. Cushing’s syndrome due to ectopic corticotropin secretion: twenty years’ experience at the national institutes of health. J Clin Endocrinol Metab. 2005;90(8):4955–62.PubMedCrossRef
12.
Isidori AM, Kaltsas GA, Pozza C, Frajese V, Newell-Price J, Reznek RH, et al. The ectopic adrenocorticotropin syndrome: clinical features, diagnosis, management, and long-term follow-up. J Clin Endocrinol Metab. 2006;91(2):371–7.PubMedCrossRef
13.
Biller BM, Grossman AB, Stewart PM, Melmed S, Bertagna X, Bertherat J, et al. Treatment of adrenocorticotropin-dependent Cushing’s syndrome: a consensus statement. J Clin Endocrinol Metab. 2008;93(7):2454–62.PubMedPubMedCentralCrossRef
14.
Mancini T, Kola B, Mantero F, Boscaro M, Arnaldi G. High cardiovascular risk in patients with Cushing’s syndrome according to 1999 WHO/ISH guidelines. Clin Endocrinol (Oxf). 2004;61(6):768–77.PubMedCrossRef
15.
Nieman LK, Ilias I. Evaluation and treatment of Cushing’s syndrome. Am J Med. 2005;118(12):1340–6.PubMedCrossRef
16.
Aggarwal S, Yadav K, Sharma AP, Sethi V. Laparoscopic bilateral transperitoneal adrenalectomy for Cushing syndrome: surgical challenges and lessons learnt. Surg Laparosc Endosc Percutan Tech. 2013;23(3):324–8.PubMedCrossRef
17.
Chow JT, Thompson GB, Grant CS, Farley DR, Richards ML, Young WF,Jr. Bilateral laparoscopic adrenalectomy for corticotrophin-dependent Cushing’s syndrome: a review of the mayo clinic experience. Clin Endocrinol (Oxf). 2008;68(4):513–9.PubMedCrossRef
18.
Feelders RA, Pulgar SJ, Kempel A, Pereira AM. The burden of cushing’s disease: clinical and health-related quality of life aspects. Eur J Endocrinol. 2012;167(3):311–26.PubMedCrossRef
19.
Nagesser SK, van Seters AP, Kievit J, Hermans J, Krans HM, van de Velde CJ. Long-term results of total adrenalectomy for Cushing’s disease. World J Surg. 2000;24(1):108–13.PubMedCrossRef
20.
Lindholm J, Juul S, Jorgensen JO, Astrup J, Bjerre P, Feldt-Rasmussen U, et al. Incidence and late prognosis of Cushing’s syndrome: a population-based study. J Clin Endocrinol Metab. 2001;86(1):117–23.PubMed
21.
Ferrer FA, MacGillivray DC, Malchoff CD, Albala DM, Shichman SJ. Bilateral laparoscopic adrenalectomy for adrenocorticotropic dependent Cushing’s syndrome. J Urol. 1997;157(1):16–8.PubMedCrossRef
22.
Ritzel K, Beuschlein F, Mickisch A, Osswald A, Schneider HJ, Schopohl J, et al. Clinical review: outcome of bilateral adrenalectomy in Cushing’s syndrome: a systematic review. J Clin Endocrinol Metab. 2013;98(10):3939–48.PubMedCrossRef
23.
Thompson SK, Hayman AV, Ludlam WH, Deveney CW, Loriaux DL, Sheppard BC. Improved quality of life after bilateral laparoscopic adrenalectomy for Cushing’s disease: a 10-year experience. Ann Surg. 2007;245(5):790–4.PubMedPubMedCentralCrossRef
24.
van Aken MO, Pereira AM, Biermasz NR, van Thiel SW, Hoftijzer HC, Smit JW, et al. Quality of life in patients after long-term biochemical cure of Cushing’s disease. J Clin Endocrinol Metab. 2005;90(6):3279–86.PubMedCrossRef
25.
Smith PW, Turza KC, Carter CO, Vance ML, Laws ER, Hanks JB. Bilateral adrenalectomy for refractory Cushing disease: a safe and definitive therapy. J Am Coll Surg. 2009;208(6):1059–64.PubMedCrossRef
26.
Hawn MT, Cook D, Deveney C, Sheppard BC. Quality of life after laparoscopic bilateral adrenalectomy for cushing’s disease. Surgery. 2002;132(6):1064–8; discussion 1068–9.
27.
Milian M, Teufel P, Honegger J, Gallwitz B, Schnauder G, Psaras T. The development of the Tuebingen Cushing’s disease quality of life inventory (Tuebingen CD-25). Part I: construction and psychometric properties. Clin Endocrinol (Oxf). 2012;76(6):851–60.
28.
Webb SM, Badia X, Barahona MJ, Colao A, Strasburger CJ, Tabarin A, et al. Evaluation of health-related quality of life in patients with Cushing’s syndrome with a new questionnaire. Eur J Endocrinol. 2008;158(5):623–30.PubMedCrossRef
29.
Smith CD, Weber CJ, Amerson JR. Laparoscopic adrenalectomy: new gold standard. World J Surg. 1999;23(4):389–96.PubMedCrossRef
30.
Agresti A. Categorical data analysis. 2nd edn. New York: Wiley; 2002.
31.
Cushing H. The basophil adenomas of the pituitary body and their clinical manifestations (pituitary basophilism). Bull Johns Hopkins Hosp. 1932;50:137–95.
32.
Alberda WJ, van Eijck CH, Feelders RA, Kazemier G, de Herder WW, Burger JW. Endoscopic bilateral adrenalectomy in patients with ectopic Cushing’s syndrome. Surg Endosc. 2012;26(4):1140–5.PubMedPubMedCentralCrossRef
33.
Boronat M, Lucas T, Barcelo B, Alameda C, Hotait H, Estrada J. Cushing’s syndrome due to autonomous macronodular adrenal hyperplasia: long-term follow-up after unilateral adrenalectomy. Postgrad Med J. 1996;72(852):614–6.PubMedPubMedCentralCrossRef
34.
Castillo OA, Foneron A, Vidal-Mora I, Sanchez-Salas R, Vitagliano G, Diaz M. Bilateral simultaneous laparoscopic adrenalectomy for congenital adrenal hyperplasia: initial experience. J Pediatr Urol. 2011;7(2):174–7.PubMedCrossRef
35.
Gagner M, Pomp A, Heniford BT, Pharand D, Lacroix A. Laparoscopic adrenalectomy: lessons learned from 100 consecutive procedures. Ann Surg. 1997;226(3):238–46; discussion 246–7.
36.
Hasan R, Harold KL, Matthews BD, Kercher KW, Sing RF, Heniford BT. Outcomes for laparoscopic bilateral adrenalectomy. J Laparoendosc Adv Surg Tech A. 2002;12(4):233–6.PubMedCrossRef
37.
Hellman P, Linder F, Hennings J, Hessman O, Eriksson B, Orlefors H, et al. Bilateral adrenalectomy for ectopic cushing’s syndrome-discussions on technique and indication. World J Surg. 2006;30(5):909–16.PubMedCrossRef
38.
Hsu TH, Gill IS. Bilateral laparoscopic adrenalectomy: retroperitoneal and transperitoneal approaches. Urology. 2002;59(2):184–9.PubMedCrossRef
39.
Kebebew E, Siperstein AE, Duh QY. Laparoscopic adrenalectomy: the optimal surgical approach. J Laparoendosc Adv Surg Tech A. 2001;11(6):409–13.PubMedCrossRef
40.
Lamas C, Alfaro JJ, Lucas T, Lecumberri B, Barcelo B, Estrada J. Is unilateral adrenalectomy an alternative treatment for ACTH-independent macronodular adrenal hyperplasia?: Long-term follow-up of four cases. Eur J Endocrinol. 2002;146(2):237–40.PubMedCrossRef
41.
Lee J, El-Tamer M, Schifftner T, Turrentine FE, Henderson WG, Khuri S, et al. Open and laparoscopic adrenalectomy: analysis of the national surgical quality improvement program. J Am Coll Surg. 2008;206(5):953–9; discussion 959–61.
42.
Meyers RL, Grua JR. Bilateral laparoscopic adrenalectomy: a new treatment for difficult cases of congenital adrenal hyperplasia. J Pediatr Surg. 2000;35(11):1586–90.PubMedCrossRef
43.
Muramaki M, Okada H, Sakai Y, Gotoh A, Fujisawa M, Kamidono S, et al. Adrenocorticotropin-independent macronodular adrenal hyperplasia treated by simultaneous bilateral laparoscopic adrenalectomy. Int J Urol. 2003;10(8):449–52.PubMedCrossRef
44.
Ogura M, Kusaka I, Nagasaka S, Yatagai T, Shinozaki S, Itabashi N, et al. Unilateral adrenalectomy improves insulin resistance and diabetes mellitus in a patient with ACTH-independent macronodular adrenal hyperplasia. Endocr J. 2003;50(6):715–21.PubMedCrossRef
45.
Perry RR, Nieman LK, Cutler GB,Jr, Chrousos GP, Loriaux DL, Doppman JL, et al. Primary adrenal causes of Cushing’s syndrome. Diagnosis and surgical management. Ann Surg. 1989;210(1):59–68.PubMedCrossRef
46.
Raffaelli M, Brunaud L, De Crea C, Hoche G, Oragano L, Bresler L, et al. Synchronous bilateral adrenalectomy for Cushing’s syndrome: laparoscopic versus posterior retroperitoneoscopic versus robotic approach. World J Surg. 2014;38(3):709–15.PubMedCrossRef
47.
Taskin HE, Aliyev S, Aksoy E, Hamrahian A, Siperstein A, Berber E. Bilateral posterior retroperitoneal robotic adrenalectomy for ACTH-independent cushing syndrome. Surg Laparosc Endosc Percutan Tech. 2014;24(3):e113–5.PubMedCrossRef
48.
Van Wyk JJ, Ritzen EM. The role of bilateral adrenalectomy in the treatment of congenital adrenal hyperplasia. J Clin Endocrinol Metab. 2003;88(7):2993–8.PubMedCrossRef
49.
Vereczkei A, Molnar A, Horvath OP. Minimally invasive technique as the gold standard of adrenal surgery. Magy Seb. 2012;65(5):365–9.PubMedCrossRef
50.
Jager F, Heintz A, Junginger T. Synchronous bilateral endoscopic adrenalectomy: experiences after 18 operations. Surg Endosc. 2004;18(2):314–8.PubMedCrossRef
51.
Fernandez-Cruz L, Saenz A, Benarroch G, Astudillo E, Taura P, Sabater L. Laparoscopic unilateral and bilateral adrenalectomy for cushing’s syndrome. Transperitoneal and retroperitoneal approaches. Ann Surg. 1996;224(6):727–34; discussion 734–6.
52.
Takata MC, Kebebew E, Clark OH, Duh QY. Laparoscopic bilateral adrenalectomy: results for 30 consecutive cases. Surg Endosc. 2008;22(1):202–7.PubMedCrossRef
53.
Tiyadatah BN, Kalavampara SV, Sukumar S, Mathew G, Pooleri GK, Prasanna AT, et al. Bilateral simultaneous laparoscopic adrenalectomy in cushing’s syndrome: safe, effective, and curative. J Endourol. 2012;26(2):157–63.PubMedCrossRef
54.
Jex RK, van Heerden JA, Carpenter PC, Grant CS. Ectopic ACTH syndrome. Diagnostic and therapeutic aspects. Am J Surg. 1985 Feb;149(2):276–82.
55.
Invitti C, Giraldi FP, de Martin M, Cavagnini F. Diagnosis and management of cushing’s syndrome: results of an italian multicentre study. study group of the italian society of endocrinology on the pathophysiology of the hypothalamic-pituitary-adrenal axis. J Clin Endocrinol Metab. 1999;84(2):440–8.
Metadata
Title
Long-Term Outcome of Bilateral Laparoscopic Adrenalectomy Measured by Disease-Specific Questionnaire in a Unique Group of Patients with Cushing’s Syndrome
Authors
Vladimir Neychev, MD, PhD
Seth M. Steinberg, PhD
Lily Yang, BS
Amit Mehta, MS III
Naris Nilubol, MD, FCAS
Margaret F. Keil, CRNP
Lynnette Nieman, MD
Constantine A. Stratakis, MD, DMSci
Electron Kebebew, MD, FACS
Publication date
01-12-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue Special Issue 3/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4605-1

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