A Case of Bilateral ACTH-independent Adrenal Adenomas with Cushing's Syndrome Treated by Ipsilateral Total and Contralateral Partial Laparoscopic Adrenalectomy

Abstract

ACTH-independent Cushing syndrome, which is mainly caused by a unilateral adrenal adenoma or adrenal carcinoma, account for 15~20% of Cushing’s syndrome. Cushing’s syndrome caused by bilateral adrenal masses is rare, including bilateral adrenal adenomas or carcinomas (AIMAH and PPNAD). Adrenal adenoma is commonly treated by Laparoscopic total adrenalectomy. However, bilateral total adrenalectomy causes acute adrenal insufficiency (Addisonian crisis), requiring lifelong steroid replacement. We present a young female patient with bilateral adrenocortical adenoma causing Cushing’s syndrome who was completely cured by successful laparoscopic total & partial adrenalectomy. Primarily we decided to remove the right adrenal gland to preserve the residual function of the left adrenal gland. However, after right total adrenalectomy, the patient manifested symptoms of subclinical Cushing syndrome including hypertension, truncal obesity, diabetes, low HDL cholesterol, and elevated triglycerides. Subsequently the patient underwent partial left adrenal mass excision, preserving the normal portion of the adrenal gland. The patient thereafter achieved biochemical resolution and significant improvement of hypertension, obesity, and diabetes without the need of any medication.