Pitfalls in the management of Cushing’s disease

Bademci, G.

doi:10.1016/j.jocn.2006.10.004

Cited by 6 publications

(6 citation statements)

References 81 publications

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“…These effects include cortisol-induced complications, such as increased cardiovascular risks and thromboembolism, musculoskeletal impairments, immunosuppression, and diabetes. 4,31 It is associated with increased morbidity and mortality, psychological effects, and ultimately decreased quality of life. 31,43 Patients may present with characteristic features of CS, including moon facies, central obesity, wide purple striae, proximal muscle weakness, and the development of a posterior cervical fat pad, or "buffalo hump."…”

Section: Neurosurgical Focusmentioning

confidence: 99%

“…30,42 Those patients with untreated CS have a 5-fold increased mortality rate with a mean survival time from initial presentation of 5 years, and therefore effective treatment is critical. 4,15,29 Predominant causes of death are due to cardiovascular complications and infections. Cushing's syndrome also AbbreviAtioNs ACTH = adrenocorticotropic hormone; BLA = bilateral adrenalectomy; CD = Cushing's disease; CRH = corticotropin-releasing hormone; CS = Cushing's syndrome; SRS = stereotactic radiosurgery; TSS = transsphenoidal surgery.…”

Section: Neurosurgical Focusmentioning

confidence: 99%

“…6 The objectives in the treatment of CS are to: 1) reverse the clinical consequences of hypercortisolism; 2) normalize biochemistry and prevent inappropriate ACTH and cortisol secretion; 3) prevent recurrence; and 4) minimize treatment morbidity. 4,43 During the 1950s, bilateral adrenalectomy (BLA) was the treatment of choice for CD, boasting a high success rate in reversing hypercortisolism, ranging from 88% to 100%. 21 Eventually it was found that there was significant risk of developing Nelson's syndrome after BLA, where risks started outweighing the benefits and thus its role as first-line treatment was abandoned.…”

mentioning

confidence: 99%

“…21 Eventually it was found that there was significant risk of developing Nelson's syndrome after BLA, where risks started outweighing the benefits and thus its role as first-line treatment was abandoned. 4 Soon after, with the advent of transsphenoidal surgery (TSS) and recognition of the pituitary gland as the primary source of the problem, the treatment strategy shifted to a more targeted therapy toward the aberrant pituitary source. Currently, the first-line treatment of CD is transsphenoidal resection of the pituitary adenoma.…”

mentioning

confidence: 99%

“…18 Additionally, medical therapy is only palliative and does not serve as a definitive curative treatment because discontinuation of medical treatment will result in the recurrence of symptoms. 4,24 A study by Morris et al demonstrated that patients who were treated only medically with steroidogenesis inhibition were more likely to die of Cushing's-related sequelae, whereas those who additionally underwent adrenalectomy (steroidogenesis inhibition + BLA) were not. 27 Bilateral adrenalectomy therefore plays a crucial role in the treatment of refractory CD and provides prompt and reliable relief of hypercortisolemia.…”

mentioning

confidence: 99%

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The role of bilateral adrenalectomy in the treatment of refractory Cushing's disease

Wong¹,

Eloy

Liu

2015

FOC

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Cushing's syndrome (CS) results from sustained exposure to excessive levels of free glucocorticoids. One of the main causes of CS is excessive adrenocorticotropic hormone (ACTH) secretion by tumors in the pituitary gland (Cushing's disease [CD]). Cushing's disease and its associated hypercortisolism have a breadth of debilitating symptoms associated with an increased mortality rate, warranting urgent treatment. Currently, the first line of treatment for CD is transsphenoidal surgery (TSS), with excellent long-term results. Transsphenoidal resections performed by experienced surgeons have shown remission rates ranging from 70% to 90%. However, some patients do not achieve normalization of their hypercortisolemic state after TSS and continue to have persistent or recurrent CD. For these patients, various therapeutic options after failed TSS include repeat TSS, radiotherapy, medical therapy, and bilateral adrenalectomy (BLA). Bilateral adrenalectomy has been shown to be a safe and effective treatment modality for persistent or recurrent CD with an immediate and definitive cure of the hypercortisolemic state. BLA was traditionally performed through an open approach, but since the advent of laparoscopic adrenalectomy, the laparoscopic approach has become the surgical method of choice. Advances in technology, refinement in surgical skills, competency in adrenopathology, and emphasis on multidisciplinary collaborations have greatly reduced morbidity and mortality associated with adrenalectomy surgery in a high-risk patient population. In this article, the authors review the role of BLA in the treatment of refractory CD. The clinical indications, current surgical and endocrinological results reported in the literature, surgical technique (open vs laparoscopic), drawbacks, and complications of BLA are discussed.

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