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

Chow, John T.; Thompson, Geoffrey B.; Grant, Clive S.; Farley, David R.; Richards, Melanie L.; Young, William F.

doi:10.1111/j.1365-2265.2007.03082.x

Cited by 92 publications

(72 citation statements)

References 49 publications

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“…Nevertheless, patients with Cushing syndrome submitted to adrenalectomy also showed a reduction of obesity (Chow et al 2008). In this study, MSG-obese rats submitted to adrenalectomy presented low corticosterone levels and attenuated obesity.…”

Section: Figurementioning

confidence: 76%

HPA axis and vagus nervous function are involved in impaired insulin secretion of MSG-obese rats

Miranda

Torrezan

Oliveira

et al. 2016

Journal of Endocrinology

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Neuroendocrine dysfunctions such as the hyperactivity of the vagus nerve and hypothalamus–pituitary–adrenal (HPA) axis greatly contribute to obesity and hyperinsulinemia; however, little is known about these dysfunctions in the pancreatic β-cells of obese individuals. We used a hypothalamic-obesity model obtained by neonatal treatment with monosodiuml-glutamate (MSG) to induce obesity. To assess the role of the HPA axis and vagal tonus in the genesis of hypercorticosteronemia and hyperinsulinemia in an adult MSG-obese rat model, bilateral adrenalectomy (ADX) and subdiaphragmatic vagotomy (VAG) alone or combined surgeries (ADX–VAG) were performed. To study glucose-induced insulin secretion (GIIS) and the cholinergic insulinotropic process, pancreatic islets were incubated with different glucose concentrations with or without oxotremorine-M, a selective agonist of the M3muscarinic acetylcholine receptor (M3AChR) subtype. Protein expression of M3AChR in pancreatic islets, corticosteronemia, and vagus nerve activity was also evaluated. Surgeries reduced 80% of the body weight gain. Fasting glucose and insulin were reduced both by ADX and ADX–VAG, whereas VAG was only associated with hyperglycemia. The serum insulin post-glucose stimulation was lower in all animals that underwent an operation. Vagal activity was decreased by 50% in ADX rats. In the highest glucose concentration, both surgeries reduced GIIS by 50%, whereas ADX-VAG decreased by 70%. Additionally, M3AChR activity was recovered by the individual surgeries. M3AChR protein expression was reduced by ADX. Both the adrenal gland and vagus nerve contribute to the hyperinsulinemia in the MSG model, although adrenal is more crucial as it appears to modulate parasympathetic activity and M3AChR expression in obesity.

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Section: Figurementioning

confidence: 76%

HPA axis and vagus nervous function are involved in impaired insulin secretion of MSG-obese rats

Miranda

Torrezan

Oliveira

et al. 2016

Journal of Endocrinology

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“…13 Laparoscopic adrenalectomy was initiated by Michel Gagner in 1992 14 and it was soon established as the standard procedure for the surgical treatment of patients with unilateral adrenal diseases. The experience with laparoscopic SBA was slower to be reported and was found to have higher rate of complications compared with unilateral laparoscopic adrenalectomy, 15,16 but the overall benefits became easily apparent. Several large series of laparoscopic SBA included 30 patients 17 and 68 patients 18 reported positive outcomes and found that the procedure was safe and effective.…”

Section: Discussionmentioning

confidence: 99%

Bilateral adrenalectomy: a review of 10 years’ experience

Maccora

Walls

Sadler

et al. 2017

annals

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INTRODUCTIONThe 2012 British Association of Endocrine and Thyroid Surgeons audit report showed that only 86 of 1359 patients who underwent adrenalectomy had a bilateral operation; thus the experience with this procedure remains limited. METHODS Retrospective review of patients undergoing bilateral adrenalectomy in a tertiary referral centre. RESULTS Between November 2005 and January 2016, bilateral adrenalectomy was performed in 23 patients (6 male, 17 female, age 43 ± 4 years) diagnosed with Cushing's disease (n = 13), hereditary phaeochromocytomas (n = 6), adrenocortical cancer (n = 2), colorectal metastatic disease (n = 1) and adrenocortical adenomas (n = 1).A laparoscopic transperitoneal approach was used in 17 patients, with one conversion to open. Three patients had open adrenalectomies for adrenocortical cancer and for simultaneous phaeochromocytomas and pancreatic neuroendocrine tumours in a patient with Von Hippel-Lindau syndrome. Three patients with Cushing's had a bilateral retroperitoneoscopic operation. The mean operating time was 195 ± 16 minutes for laparoscopic operations (n = 16), 243 ± 44 minutes for open adrenalectomies (n = 4) and 151 ± 12 minutes for retroperitoneal operations. It was significantly shorter for Cushing's disease than for phaeochromocytomas (162 ± 8 vs. 257 ± 39 minutes, P < 0.01).Median length of hospital stay was 5 days. Postoperative complications (Clavien-Dindo classification) included one chest infection (level 2), one postoperative haemorrhage and two chest drains for pneumothorax (level 3), two postoperative cardiac arrests (level 4) and one late cancer death from complications related to uncontrolled hypercortisolism (level 5). DISCUSSION Synchronous bilateral adrenalectomy remains an infrequent operation. The laparoscopic approach is feasible in the majority of patients. It is likely that the retroperitoneoscopic adrenalectomy will become the standard approach for bilateral operations.

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“…The risk of CD recurrence can reach 25%, 3 years after surgery (Patil et al 2008). Second and third line therapies such as a second pituitary surgery (Patil et al 2008, Fleseriu 2012, pituitary irradiation (conventional and/or stereotactic) (Estrada et al 1997, Tritos et al 2011 and bilateral adrenalectomy (Young & Thompson 2005, Assie et al 2007, Chow et al 2008, Ritzel et al 2013) have been utilized with variable results and specific complications.…”

Section: Overview Of CD Therapymentioning

confidence: 99%

Treatment of Cushing's disease: a mechanistic update

Cuevas‐Ramos¹,

Fleseriu²

2014

Journal of Endocrinology

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Cushing's disease (CD) is characterized by an ACTH-producing anterior corticotrope pituitary adenoma. If hypothalamus-pituitary-adrenal (HPA) axis physiology is disrupted, ACTH secretion increases, which in turn stimulates adrenocortical steroidogenesis and cortisol production. Medical treatment plays an important role for patients with persistent disease after surgery, for those in whom surgery is not feasible, or while awaiting effects of radiation. Multiple drugs, with different mechanisms of action and variable efficacy and tolerability for controlling the deleterious effects of chronic glucocorticoid excess, are available. The molecular basis and clinical data for centrally acting drugs, adrenal steroidogenesis inhibitors, and glucocorticoid receptor antagonists are reviewed, as are potential novel molecules and future possible targets for CD treatment. Although progress has been made in the understanding of specific corticotrope adenoma receptor physiology and recent clinical studies have detected improved effects with a combined medical therapy approach, there is a clear need for a more efficacious and better-tolerated medical therapy for patients with CD. A better understanding of the molecular mechanisms in CD and of HPA axis physiology should advance the development of new drugs in the future.

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

Abstract: This study further supports the role of BLA as an effective treatment option for patients with ACTH-dependent Cushing's syndrome.

Cited by 92 publications

References 49 publications

HPA axis and vagus nervous function are involved in impaired insulin secretion of MSG-obese rats

HPA axis and vagus nervous function are involved in impaired insulin secretion of MSG-obese rats

Bilateral adrenalectomy: a review of 10 years’ experience

Treatment of Cushing's disease: a mechanistic update

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