Bilateral Adrenalectomy for Ectopic Cushing’s Syndrome—Discussions on Technique and Indication

Abstract

We conclude that bilateral handport-assisted laparoscopic adrenalectomy is safe, and that all surgical techniques in these severely ill patients may be troublesome and technically demanding. Early surgical intervention may reduce the technical disadvantages. Moreover, bilateral adrenalectomy can substantially reduce the symptoms of Cushing's syndrome, although effects on mortality are not obvious.

Bilateral laparoscopic adrenalectomy for corticotrophin–dependent Cushing's syndrome: a review of the Mayo Clinic experience

“…When compared head to head, neither transperitoneal or retroperitoneal has been shown to be consistently superior 46,47 . Handport‐assisted laparoscopic adrenalectomy, used infrequently in this series, has been reported at some centres, with advantages including improved tactile sensation leading to reduced incidence of adrenal remnant 20,48,49 . Open anterior adrenalectomy remains a consideration when concomitant intra‐abdominal procedures are necessary in select patients with ectopic ACTH syndrome (e.g.…”

A challenging case of laparoscopic synchronous bilateral adrenalectomy for Cushing's disease. Case report

“…Cushing's disease is ACTH-dependent and is accompanied by bilateral diffuse adreno-cortical hyperplasia, which is usually treated by trans-sphenoid surgery or bilateral total adrenalectomy [ 6 ]. In these cases, laparoscopic bilateral adrenalectomy has been described and can offer definitive treatment with low morbidity and less complications than open surgery [ 7 , 8 ].…”

Acute hypercortisolism: what can the surgeon offer?

“…In the pre‐operative setting, a balance needs to be struck between the unproven benefits of medical control of hypercortisolism vs the toxicity of pharmacological blockade and the time taken to achieve this along with the risk of a poor response with subsequent delayed surgical treatment. Again decisions should be tailored to the individual, but in general we recommend consideration of early bilateral adrenalectomy, particularly in those with poor initial response to medical therapy . Surgery should be centralized to centres with experience in adrenalectomy in this setting.…”

“…Again decisions should be tailored to the individual, but in general we recommend consideration of early bilateral adrenalectomy, particularly in those with poor initial response to medical therapy. 23 Surgery should be centralized to centres with experience in adrenalectomy in this setting.…”