Unilateral adrenalectomy for the treatment of refractory or recurrent Cushing disease: report of 10 cases

Abstract

Objective To discuss the value of unilateral adrenalectomy （UA） fur the treatment of refractory or recurrent Cushing disease （RRCD）. Methods From January 2003 to July 2011, 10 patients with RRCD underwent UA. The preoperative symptoms, preoperative treatments, intra- and post-operative complications and follow-up in patients were reviewed. All the 10 patients presented with hypercortisolemia symptoms. Transsphenoidal surgery had been performed in 9 patients as initial therapy. Of the 10 patients, 8 received radiation therapy before adrenaleetomy. All the 10 cases accepted a right UA. Results No perioperative complications occurred. The 10 patients were followed up for 1 -8 years. Eight patients with radiation therapy before adrenalectomy got remission. Two bilateral adrenalectomies were eventually per- formed because the symptoms could not be controlled. Of the 8 patients who got remission, none of them de- veloped Nelson syndrome and none need lifelong mineralocorticoid and glucoeorticoid replacement therapy. Conclusions UA could be an option for RRCD. For patients with RRCD receiving radiation therapy, UA may effectively relief hypercortisolemia. Compared with bilateral adrenalectomies, UA could avert permanent adrenal insufficiency, which leads to a lifelong glucocorticoid and mineralocorticoid replacement therapies, and a life-threatening adrenal crisis. Key words: Adrenalectomy; Cushing disease; Hypercortisolemia; Refractory; Recurrence