MP37-09 CLINICAL OUTCOME OF LAPAROSCOPIC ADRENALECTOMY IN SUB CLINICAL CUSHING SYNDROME; IS SURGICAL REMOVAL BETTER OR NOT?

Abstract

You have accessJournal of UrologyAdrenal1 Apr 2017MP37-09 CLINICAL OUTCOME OF LAPAROSCOPIC ADRENALECTOMY IN SUB CLINICAL CUSHING SYNDROME; IS SURGICAL REMOVAL BETTER OR NOT? Miki Fuse, Shinichi Sakamoto, Kodai Sato, Takaaki Tamura, Akinori Takei, Satoshi Yamamoto, Yusuke Imamura, Koji Kawamura, Takashi Imamoto, Akira Komiya, and Tomohiko Ichikawa Miki FuseMiki Fuse More articles by this author , Shinichi SakamotoShinichi Sakamoto More articles by this author , Kodai SatoKodai Sato More articles by this author , Takaaki TamuraTakaaki Tamura More articles by this author , Akinori TakeiAkinori Takei More articles by this author , Satoshi YamamotoSatoshi Yamamoto More articles by this author , Yusuke ImamuraYusuke Imamura More articles by this author , Koji KawamuraKoji Kawamura More articles by this author , Takashi ImamotoTakashi Imamoto More articles by this author , Akira KomiyaAkira Komiya More articles by this author , and Tomohiko IchikawaTomohiko Ichikawa More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1141AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although no definitive surgical guide line exist in Sub-clinical Cushing Syndrome: SCS, surgical resection is considered based on the presence of hyper tension (HT), diabetes mellitus (DM) and hyper lipidemia (HL). Cortisole(CS) level > 3μg/dL after use of 1mg dexamethasone(Dex) was the U.S. guideline of SCS, while >1.8µg/dL in Japanese guideline. In this analysis, we have studied the clinical benefit of surgically removal in SCS tumor, especially patients with gray zone(between US and Japanese guideline);1.8≤CS<3.0µg/dL after Dex 1mg treatment. METHODS Total of 112 patients diagnosed as SCS between 1997 and 2015 were included in this study. 94 patients underwent surgical adrenalectomy and 18 patients were none surgically observed. Clinical outcome such as HT, DM, HL and body mass index(BMI) were retrospectively analyzed. All the surgical adrenalectomies were performed by retroperitoneal laparoscopic adrenalectomy. RESULTS Median age was 65 years. Median tumor diameters were 30 mm. Significant improvement in HT (P<.0001), HbA1c (P=0.016) and BMI (P=0.0018) were observed in overall surgically removed SCS patients. Significant improvements in HT (P=0.034) and BMI (P=0.042) were also observed in 1.8≤CS<3.0µg/dL group after surgery. However, clinical improvement were more evident in ≥3.0µg/dL group, such as HT (P=0.0002), HbA1c (P=0.028) and HDL-C(P=0.046), while no clinical improvement were observed in ≤1.8µg/dL groups. Although not reached statistical significance, surgical removal groups tends to show the reduction in prescribed drugs compare to none surgical groups(drugs related to DM 23 vs 10% p=0.073, HT 37 vs 11% P=0.078 and HL 43% vs 11% P=0.282). CONCLUSIONS The current data showed that surgically removal of SCS tumor mediated significant improvements in the clinical symptoms. Based on expected clinical benefit,the gray zone SCS patients; 1.8≤CS<3.0µg/dL after Dex 1mg treatment may also be a optimal candidate for laparoscopic adrenalectomy. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e478 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Miki Fuse More articles by this author Shinichi Sakamoto More articles by this author Kodai Sato More articles by this author Takaaki Tamura More articles by this author Akinori Takei More articles by this author Satoshi Yamamoto More articles by this author Yusuke Imamura More articles by this author Koji Kawamura More articles by this author Takashi Imamoto More articles by this author Akira Komiya More articles by this author Tomohiko Ichikawa More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...