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Laparoscopic adrenalectomy in patients with subclinical Cushing syndrome

Abstract

Background

Subclinical Cushing syndrome in patients with adrenal incidentalomas has been associated with an increased prevalence of the metabolic syndrome and cardiovascular risk. The management of these patients, be it conservative or surgical, is still debated, but there is accumulating evidence that surgery is best and that laparoscopic adrenalectomy, when possible, is the most preferred procedure. Here we present the short- and long-term results of laparoscopic adrenalectomy for subclinical Cushing syndrome and determine the effect of this procedure on components of the metabolic syndrome.

Methods

Twenty-nine patients, 8 men and 21 women with adrenal incidentalomas and subclinical Cushing syndrome who underwent laparoscopic adrenalectomy, were studied retrospectively. They had undergone postoperative follow-up for improvement or worsening of their arterial blood pressure, body weight, and fasting glucose level for a mean period of 77 months.

Results

Preoperatively, 17 patients (58.6 %) had arterial hypertension, 14 (48.3 %) had a body mass index exceeding 27 kg/m2, and 12 (41.4 %) had diabetes mellitus. Postoperatively, a decrease in mean arterial pressure was found in 12 patients (70.6 %), a decrease in body mass index in 6 patients (42.9 %), and an improvement in glycemic control in 5 patients (41.7 %).

Conclusions

Laparoscopic adrenalectomy is beneficial in many patients with subclinical Cushing syndrome because it reduces arterial blood pressure, body weight, and fasting glucose levels. Prospective randomized studies are needed to compare laparoscopic adrenalectomy with a conservative approach and to confirm these results.

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References

  1. 1.

    Guerrieri M, De Sanctis A, Crosta F et al (2007) Adrenal incidentaloma: surgical update. J Endocrinol Invest 30:200–204

  2. 2.

    Young WF Jr (2007) Clinical practice. The incidentally discovered adrenal mass. N Engl J Med 356:601–610

  3. 3.

    National Institutes of Health (2002) NIH state-of-the-science statement on management of the clinically inapparent adrenal mass (“incidentaloma”). NIH consensus and state-of-the-science statements. National Institutes of Health, Bethesda, pp 1–23

  4. 4.

    Piaditis GP, Kaltsas GA, Androulakis II et al (2009) High prevalence of autonomous cortisol and aldosterone secretion from adrenal adenomas. Clin Endocrinol (Oxf) 71:772–778

  5. 5.

    Vassilatou E, Vryonidou A, Michalopoulou S et al (2009) Hormonal activity of adrenal incidentalomas: results from a long-term follow-up study. Clin Endocrinol (Oxf) 70:674–679

  6. 6.

    Zeiger MA, Thompson GB, Duh QY et al (2009) The American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons medical guidelines for the management of adrenal incidentalomas. Endocr Pract 15(suppl 1):1–20

  7. 7.

    Akaza I, Yoshimoto T, Iwashima F et al (2011) Clinical outcome of subclinical Cushing’s syndrome after surgical and conservative treatment. Hypertens Res 34:1111–1115

  8. 8.

    Chiodini I, Morelli V, Salcuni AS et al (2010) Beneficial metabolic effects of prompt surgical treatment in patients with an adrenal incidentaloma causing biochemical hypercortisolism. J Clin Endocrinol Metab 95:2736–2745

  9. 9.

    Toniato A, Merante-Boschin I, Opocher G, Pelizzo MR, Schiavi F, Ballotta E (2009) Surgical versus conservative management for subclinical Cushing syndrome in adrenal incidentalomas: a prospective randomized study. Ann Surg 249:388–391

  10. 10.

    Mantero F, Masini AM, Opocher G, Giovagnetti M, Arnaldi G (1997) Adrenal incidentaloma: an overview of hormonal data from the National Italian Study Group. Horm Res 47:284–289

  11. 11.

    Mantero F, Terzolo M, Arnaldi G et al (2000) A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. J Clin Endocrinol Metab 85:637–644

  12. 12.

    Tauchmanovà L, Rossi R, Biondi B et al (2002) Patients with subclinical Cushing’s syndrome due to adrenal adenoma have increased cardiovascular risk. J Clin Endocrinol Metab 87:4872–4878

  13. 13.

    Angeli A, Terzolo M (2002) Adrenal incidentaloma—a modern disease with old complications. J Clin Endocrinol Metab 87:4869–4871

  14. 14.

    Terzolo M, Stigliano A, Chiodini I et al (2011) Italian Association of Clinical Endocrinologists (2011) AME position statement on adrenal incidentaloma. Eur J Endocrinol 164:851–870

  15. 15.

    Ogilvie JB, Duh QY (2005) New approaches to the minimally invasive treatment of adrenal lesions. Cancer J 11:64–72

  16. 16.

    Kwok KC, Lo CY (2003) Applicability and outcome of laparoscopic adrenalectomy. Asian J Surg 26:71–75

  17. 17.

    Bonjer HJ, Sorm V, Berends FJ et al (2000) Endoscopic retroperitoneal adrenalectomy: lessons learned from 111 consecutive cases. Ann Surg 232:796–803

  18. 18.

    Zografos GN, Farfaras A, Vasiliadis G, Pappa T, Aggeli C et al (2006) Laparoscopic surgery for adrenal tumors. A retrospective analysis. Hormones (Athens) 5:52–56

  19. 19.

    Bjornsson B, Birgisson G, Oddsdottir M (2008) Laparoscopic adrenalectomies: a nationwide single-surgeon experience. Surg Endosc 22:622–626

  20. 20.

    Lezoche E, Guerrieri M, Crosta F et al (2008) Perioperative results of 214 laparoscopic adrenalectomies by anterior transperitoneal approach. Surg Endosc 22:522–526

  21. 21.

    Ramacciato G, Nigri GR, Petrucciani N et al (2011) Minimally invasive adrenalectomy: a multicenter comparison of transperitoneal and retroperitoneal approaches. Am Surg 77:409–416

  22. 22.

    Reincke M, Nieke J, Krestin GP, Saeger W, Allolio B, Winkelmann W (1992) Preclinical Cushing’s syndrome in adrenal “incidentalomas”: comparison with adrenal Cushing’s syndrome. J Clin Endocrinol Metab 75:826–832

  23. 23.

    Terzolo M, Bovio S, Pia A et al (2007) Subclinical Cushing’s syndrome. Arq Bras Endocrinol Metabol 51:1272–1279

  24. 24.

    Guerrieri M, Campagnacci R, Patrizi A, Romiti C, Arnaldi G, Boscaro M (2010) Primary adrenal hypercortisolism: minimally invasive surgical treatment or medical therapy? A retrospective study with long-term follow-up evaluation. Surg Endosc 24:2542–2546

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Disclosures

Drs. Perysinakis, Marakaki, Avlonitis, Katseli, Vassilatou, Papanastasiou, Piaditis, and Zografos have no conflicts of interest or financial ties to disclose.

Author information

Correspondence to George N. Zografos.

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Perysinakis, I., Marakaki, C., Avlonitis, S. et al. Laparoscopic adrenalectomy in patients with subclinical Cushing syndrome. Surg Endosc 27, 2145–2148 (2013). https://doi.org/10.1007/s00464-012-2730-5

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Keywords

  • Adenoma
  • Autonomous cortisol secretion
  • Conservative treatment
  • Laparoscopic adrenalectomy
  • Subclinical Cushing syndrome