A-200 BILATERAL ADRENALECTOMY: EXPERIENCE FROM AN ENDOCRINE SURGERY REFERENCE CENTER

Abstract

Abstract Background Synchronous bilateral adrenalectomy (BA) remains one of the least frequently performed surgeries worldwide, as only selected patients are eligible. Consequently, experience in this regard remains limited. Methods Retrospective data analysis of all patients who underwent synchronous bilateral adrenalectomy from 2011 to 2022 was performed. Results Single-stage bilateral adrenalectomy was performed in n=17 patients (n=10 female, n=7 male, age: 48 ± 17 years) with Cushing's syndrome (n=11; including 7 ectopic ACTH production (EA) and 4 therapy-refractory Cushing's syndrome (CD)), pheochromocytoma (n=3), adrenal carcinoma (n=1), metastases (n=1), and adenomas (n=1). Minimally invasive (MI) surgery was performed in n=15 cases; open surgery in n=2. Mean operative time was 200 ± 68 mins. and median hospital stay was 22 d (IQR 6-35 d). In n=3 cases, surgery was an emergency-procedure; in all 3 cases, indication was Cushing's crisis in EA. These 3 patients died within the first 4 months after surgery due to septic complications of derailed Cushing's or underlying malignancy. While duration of surgery and hospital stay did not differ, emergency patients were significantly older (69 ± 9 vs. 43 ± 14 years; p=0.01) and ICU stay was significantly longer (29 ± 17 vs. 3 ± 7 days; p=0.001). Conclusion Single-stage bilateral adrenalectomy remains a rarely performed procedure. The MI procedure represents the standard. Patients who need emergency surgery due to a Cushing's crisis have a very high mortality. Thus, timing of surgery is of highest priority and requires a critical interdisciplinary discussion.