Andrea Oßwald1, Eva Plomer1, Christina Dimopoulou2, Monika Milian1, Rainer Blaser1, Katrin Ritzel1, Anne Mickisch1, Ferengis Knerr1, Milan Stanojevic1, Klaus Hallfeldt1, Jochen Schopohl1, Klaus A Kuhn1, Günter Stalla1, Felix Beuschlein1, Martin Reincke3. 1. Medizinische Klinik und Poliklinik IVLudwig-Maximilians-Universität München, Klinikum der Universität München, Ziemssenstraße 1, D-80336 Munich, GermanyDepartment of EndocrinologyMax Planck Institute of Psychiatry, München, GermanyDepartment of NeurosurgeryUniversity Hospital Tuebingen, Tübingen, GermanyIMSEKlinikum rechts der Isar der TU München, München, Germany andChirurgische Klinik und Poliklinik - InnenstadtKlinikum der Ludwig-Maximilians-Universität München, München, Germany. 2. Medizinische Klinik und Poliklinik IVLudwig-Maximilians-Universität München, Klinikum der Universität München, Ziemssenstraße 1, D-80336 Munich, GermanyDepartment of EndocrinologyMax Planck Institute of Psychiatry, München, GermanyDepartment of NeurosurgeryUniversity Hospital Tuebingen, Tübingen, GermanyIMSEKlinikum rechts der Isar der TU München, München, Germany andChirurgische Klinik und Poliklinik - InnenstadtKlinikum der Ludwig-Maximilians-Universität München, München, GermanyMedizinische Klinik und Poliklinik IVLudwig-Maximilians-Universität München, Klinikum der Universität München, Ziemssenstraße 1, D-80336 Munich, GermanyDepartment of EndocrinologyMax Planck Institute of Psychiatry, München, GermanyDepartment of NeurosurgeryUniversity Hospital Tuebingen, Tübingen, GermanyIMSEKlinikum rechts der Isar der TU München, München, Germany andChirurgische Klinik und Poliklinik - InnenstadtKlinikum der Ludwig-Maximilians-Universität München, München, Germany. 3. Medizinische Klinik und Poliklinik IVLudwig-Maximilians-Universität München, Klinikum der Universität München, Ziemssenstraße 1, D-80336 Munich, GermanyDepartment of EndocrinologyMax Planck Institute of Psychiatry, München, GermanyDepartment of NeurosurgeryUniversity Hospital Tuebingen, Tübingen, GermanyIMSEKlinikum rechts der Isar der TU München, München, Germany andChirurgische Klinik und Poliklinik - InnenstadtKlinikum der Ludwig-Maximilians-Universität München, München, Germany martin.reincke@med.uni-muenchen.de.
Abstract
OBJECTIVE: Bilateral adrenalectomy (BADX) is an important treatment option for patients with Cushing's syndrome (CS). Our aim is to analyze the long-term outcomes, surgical, biochemical, and clinical as well as morbidity and mortality, of patients who underwent BADX. DESIGN: A total of 50 patients who underwent BADX since 1990 in two German centers were identified. Of them, 34 patients had Cushing's disease (CD), nine ectopic CS (ECS), and seven ACTH-independent bilateral adrenal hyperplasia (BAH). METHODS: Standardized follow-up examination was performed in 36 patients with a minimum follow-up time of 6 months after BADX and a median follow-up time of 11 years. RESULTS: Surgical morbidity and mortality were 6 and 4% respectively. All patients were found to be in remission after BADX. Almost all Cushing's-specific comorbidities except for psychiatric diseases improved significantly. Health-related quality of life remained impaired in 45.0% of female and 16.7% of male patients compared with a healthy population. The median number of adrenal crises per 100 patient-years was four. Nelson tumor occurred in 24% of CD patients after a median time span of 51 months. Long-term mortality after 10 years was high in ECS (44%) compared with CD (3%) and BAH (14%). CONCLUSIONS: BADX is an effective and relatively safe treatment option especially in patients with CD. The majority of patients experience considerable improvement of Cushing's symptoms.
OBJECTIVE: Bilateral adrenalectomy (BADX) is an important treatment option for patients with Cushing's syndrome (CS). Our aim is to analyze the long-term outcomes, surgical, biochemical, and clinical as well as morbidity and mortality, of patients who underwent BADX. DESIGN: A total of 50 patients who underwent BADX since 1990 in two German centers were identified. Of them, 34 patients had Cushing's disease (CD), nine ectopic CS (ECS), and seven ACTH-independent bilateral adrenal hyperplasia (BAH). METHODS: Standardized follow-up examination was performed in 36 patients with a minimum follow-up time of 6 months after BADX and a median follow-up time of 11 years. RESULTS: Surgical morbidity and mortality were 6 and 4% respectively. All patients were found to be in remission after BADX. Almost all Cushing's-specific comorbidities except for psychiatric diseases improved significantly. Health-related quality of life remained impaired in 45.0% of female and 16.7% of male patients compared with a healthy population. The median number of adrenal crises per 100 patient-years was four. Nelson tumor occurred in 24% of CDpatients after a median time span of 51 months. Long-term mortality after 10 years was high in ECS (44%) compared with CD (3%) and BAH (14%). CONCLUSIONS: BADX is an effective and relatively safe treatment option especially in patients with CD. The majority of patients experience considerable improvement of Cushing's symptoms.
Authors: Michael Drey; Christina M Berr; Martin Reincke; Julia Fazel; Jochen Seissler; Jochen Schopohl; Martin Bidlingmaier; Stefanie Zopp; Nicole Reisch; Felix Beuschlein; Andrea Osswald; Ralf Schmidmaier Journal: Endocrine Date: 2017-07-12 Impact factor: 3.633
Authors: Lynnette K Nieman; Beverly M K Biller; James W Findling; M Hassan Murad; John Newell-Price; Martin O Savage; Antoine Tabarin Journal: J Clin Endocrinol Metab Date: 2015-07-29 Impact factor: 5.958
Authors: Martin Reincke; Adriana Albani; Guillaume Assie; Irina Bancos; Thierry Brue; Michael Buchfelder; Olivier Chabre; Filippo Ceccato; Andrea Daniele; Mario Detomas; Guido Di Dalmazi; Atanaska Elenkova; James Findling; Ashley B Grossman; Celso E Gomez-Sanchez; Anthony P Heaney; Juergen Honegger; Niki Karavitaki; Andre Lacroix; Edward R Laws; Marco Losa; Masanori Murakami; John Newell-Price; Francesca Pecori Giraldi; Luis G Pérez-Rivas; Rosario Pivonello; William E Rainey; Silviu Sbiera; Jochen Schopohl; Constantine A Stratakis; Marily Theodoropoulou; Elisabeth F C van Rossum; Elena Valassi; Sabina Zacharieva; German Rubinstein; Katrin Ritzel Journal: Eur J Endocrinol Date: 2021-03 Impact factor: 6.664