Clinical diagnosis and treatment of Cushing syndrome caused by bilateral adrenocortical adenoma

Objective　To analyze the clinical data [tumor size and adrenal vein sampling (AVS)] of patients with Cushing syndrome (CS) caused by bilateral adrenocortical adenoma (BAA), and explore their role in determining the predominant side before operation. Methods　The clinical data were retrospectively analyzed of 11 cases of CS caused by BAA admitted in the General Hospital of Chinese PLA from Jan. 2008 to Nov. 2017. Of the 11 cases, 7 and 4 presented clinical CS and subclinical CS (SCS), respectively. Operation was performed on the determined predominant side in patients with successful AVS, while the rest of patients were operated on the larger side of the tumor. Results　Six patients underwent AVS and 3 cases got success, for whom the larger side of tumor was the predominant side in 2 patients and the smaller side of tumor was the predominant side in 1 case; The clinical manifestation after operation was better than before in 1 CS case, and no obvious change was observed in postoperative clinical manifestation in 2 SCS cases. All the patients were long-term followed up, during the period their endocrine indicators were better than those before the operation. Blood pressure and blood glucose in patients with hypertension and diabetes were easier to control than before. Eight cases were operated on the larger side of tumor. The typical symptoms and physical signs of 6 CS patients improved after operation, and the clinical manifestations of 2 SCS patients hadn't changed. Five patients were long-term followed up, and their endocrine indicators were better than those before operation. Conclusions　Successful AVS may be acted as an important indicator in preoperative preparation and evaluation in patients with CS caused by BAA, but it has high technical requirements and low success rate. If AVS is unconditional, a long term following-up will be needed after resecting the larger side of tumor. DOI: 10.11855/j.issn.0577-7402.2018.07.04