Autotransplantation of adrenal remnant to high in Cushing's disease. Preserving residual cortical activity while avoiding laparotomy.

Abstract

THE SURGICAL MANAGEMENT of Cushing's syndrome due to bilateral adrenocortical hyperplasia has always presented two hard choices. Onthe one hand, total adrenalectomy abolished the hyperadrenocorticalism, but produced permanent loss of adrenocortical function. At times this resulted in hyperpigmentation apparently due to increased pituitary elaboration of melanophore-stimulating hormone. On the other hand, subtotal adrenalectomy entailed the risk that regeneration of the residual adrenal remnant might produce recurrence of the original disease, necessitating a second and often more difficult laparotomy. It occurred to us that autotransplantation of the adrenal remnant to the thigh might provide residual adrenocortical function while precluding the need for a second laparotomy in the event of recurrence of hyperadrenocorticalism. In leaving a nubbin of left adrenal gland attached to the left renal vein by only the central adrenal vein, we had frequently achieved survival of this adrenal tissue despite the fact that it was supplied solely by venous