Long-term results of treatment of Cushing's disease by adrenalectomy.

Patients treated by adrenalectomy for suspected Cushing's syndrome were reviewed for the incidence to early and late complications, side effects, survival, and quality of life. Of a total of 141 patients, 109 had Cushing's disease, and were treated with subtotal (n = 15) or total (n = 94) adrenalectomy. All hospital charts were reviewed, and surviving patients were asked to fill in a questionnaire. Ten patients died in hospital. Morbidity was 13% (n = 18). Five patients required reoperation because of recurrent adrenal hyperplasia after subtotal adrenalectomy (n = 3) or incomplete adrenalectomy (n = 2). All patients received conventional corticosteroid supplementation. Ten patients developed Nelson's syndrome 3-20 years after adrenalectomy. Of the 109 patients with Cushing's disease 80 were alive 1-34 years after operation. Only four late deaths were related to Cushing's disease: 3 postoperative deaths followed reoperation and 1 was the result of an Addisonian crisis. About two thirds of the patients interviewed had satisfactory quality of life and were able to work. Total bilateral adrenalectomy has a five to seven fold higher perioperative mortality than transphenoidal operations. The prognosis of patients who survive the early postoperative period, however, is comparable to that of the general population.