[Outcome of pregnancy in a woman subjected to total bilateral adrenalectomy for Cushing's disease].
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Bilateral adrenalectomy
Cushing's disease
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Between 1965 and 1983, a total of 138 patients with endocrine hypertension were treated at the Münster Surgical Clinic. 71 catecholamine-producing tumors were removed in 56 patients, 60 patients had primary aldosteronism; 32 patients with Cushing's syndrome received uni- or bilateral adrenalectomy. The operative access to the adrenals was by anterior abdominal incision which we consider superior to lateral or transthoracic approaches. 35 complications occurred. The operative management of these forms of secondary hypertension, with its low overall rate of complications, is currently seen as the most successful therapeutic approach.
Primary Aldosteronism
Secondary hypertension
Bilateral adrenalectomy
Hyperaldosteronism
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Bilateral adrenalectomy
Cushing's disease
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Bilateral adrenalectomy
Cushing's disease
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Bilateral adrenalectomy
Cushing's disease
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Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
Bilateral adrenalectomy
Cushing's disease
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Cushing's disease
Bilateral adrenalectomy
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Reportedly between 8-38% of patients who receive bilateral adrenalectomy for treatment of Cushing's disease will develop Nelson's syndrome. We investigated which factors may predict the development of the syndrome. Eight of 48 patients, bilaterally adrenalectomized for pituitary-dependent Cushing's syndrome 1-30 yr previously, developed Nelson's syndrome 1.5-13 yr (6.6 +/- 4.3 yr) after adrenalectomy. The mean age at adrenalectomy in the group of patients who developed Nelson's syndrome was significantly lower than that in the group without the syndrome (mean +/- SD, 26.0 +/- 6.0 and 35.6 +/- 11.7 yr, respectively; P < 0.02). In the patients adrenalectomized before the age of 35 yr, 8 of 27 (30%) developed Nelson's syndrome, whereas in the patients older than 35 yr, no one did (P < 0.02). No statistically significant differences between the two groups were found in sex ratio, duration of disease before adrenalectomy, or duration of follow-up thereafter. There were no statistically significant differences between the two groups in mean plasma cortisol and ACTH levels before adrenalectomy, cortisol suppressibility after the administration of 8 and 16 mg dexamethasone, or cortisol responses to CRH, TRH, and LH-releasing hormone before adrenalectomy. We conclude that age at the time of adrenalectomy is an important predictive factor for the development of Nelson's syndrome.
Bilateral adrenalectomy
Cushing's disease
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Bilateral adrenalectomy
Cushing's disease
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Bilateral adrenalectomy
Cushing's disease
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Summary OBJECTIVES Bilateral adrenalectomy may be indicated in patients with Cushing's disease in whom hypercortlsolism is not resolved after pituitary microsurgery. However, Nelson's syndrome is a major long‐term complication of such therapy. We have carried out a longitudinal study on patients with Cushing's disease who underwent bilateral adrenalectomy comparing plasma /Mipotrophin ( β ‐LPH) with ACTH levels. PATIENTS AND METHODS Seven patients unsuccessfully treated by pituitary surgery for Cushing's disease underwent bilateral adrenalectomy. Blood samples were collected on days 8 and 15 and at 1, 2, 3, 6, 9,12,18 and 24 months after adrenalectomy in all patients. Five patients were followed up for the longer periods of 30,33,39,72 and 84 months respectively. Plasma ACTH and β ‐LPH were determined by RIA after extraction. Pituitary CT scan was done at 6‐8‐month intervals. RESULTS A pituitary tumour was detected in three patients at 14, 24 and 26 months after adrenalectomy respectively. The basal ACTH (range 8‐21 pmol/l) began to rise between 15 and 30 days and exhibited a sharp increase with a range of 36‐114 pmol/l at 3 months and a range of 53‐187 pmol/l at 6‐9 months after adrenalectomy. The ACTH levels in the three patients who later presented with a pituitary tumour were indistinguishable from those observed in the other patients up to 12 months after adrenalectomy. Only at 12 months or thereafter were their ACTH levels higher than in the other patients (958 ± 252 vs 205 ± 22 pmol/l). β ‐LPH concentrations changed in parallel with ACTH levels. The ACTH levels correlated positively with β ‐LPH levels ( r = 0 76). CONCLUSIONS In patients with Cushing's disease undergoing bilateral adrenalectomy, plasma ACTH and β ‐LPH concentrations cannot predict the development of pituitary tumours until 12 months after surgery.
Cushing's disease
Bilateral adrenalectomy
Basal (medicine)
Cushing Disease
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