Vol 69, No 4 (2018)
Original paper
Published online: 2018-06-19

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Effectiveness of unilateral laparoscopic adrenalectomy in ACTH-independent hypercortisolaemia and subclinical Cushing’s syndrome — a retrospective study on a large cohort

Ryszard Pogorzelski1, Sadegh Toutounchi1, Urszula Ambroziak2, Ewa Krajewska1, Tomasz Wołoszko1, Małgorzata Szostek1, Wawrzyniec Jakuczun1, Krzysztof Celejewski1, Małgorzata Legocka1, Przemysław Kwasiborski3, Zbigniew Gałązka1, Ewelina Biskup4
Pubmed: 29952409
Endokrynol Pol 2018;69(4):411-415.

Abstract

Introduction: To assess the effectiveness of early unilateral laparoscopic adrenalectomy in ACTH-independent and subclinical hypercor­tisolaemia.

Material and methods: We conducted a unicentric, retrospective study. Between 2010 and 2015, 356 laparoscopic adrenalectomies were performed in the Department of General and Endocrine Surgery of the MUW. Hypercortisolaemia was found in 50 (14%) patients, while overt hypercortisolaemia was found in 31 patients. In the hypercortisolaemia group, ACTH-dependent hypercortisolaemia was diagnosed in five (10%) and ACTH-independent hypercortisolaemia in 25 patients (50%). One patient with overt hypercortisolaemia had cancer of the adrenal cortex. The remaining 19 (38%) patients had subclinical Cushing’s syndrome. For our study, we compared patients with ACTH-independent hypercortisolaemia (n = 25) with those with Cushing’s syndrome (n = 19). Patients with ACTH-dependent hyper­cortisolaemia (n = 5) and the patient with cancer of the adrenal cortex (n = 1) were excluded.

Results: Patients from both groups (n = 44) underwent a unilateral transperitoneal adrenalectomy. Good early outcomes were observed in 42 patients (93.3%). In one patient, an additional laparoscopic surgery was necessary on postoperative day 0 due to bleeding. In another patient, on day 22 post-surgery, we found an abscess in the site of the excised adrenal gland, which was drained under laparoscopic guid­ance. In three patients (6.8%) with substantial obesity, temporary respiratory insufficiency of varying degrees occurred. We did not observe any thromboembolic complications. All patients with overt hypercortisolaemia and nine patients with subclinical hypercortisolaemia had secondary adrenal insufficiency postoperatively.

Conclusions: Transperitoneal unilateral laparoscopic adrenalectomy is an efficient and safe treatment option in patients with ACTH- -independent hypercortisolaemia, both overt and subclinical.

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