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Bilateral Adrenalectomy: Differences between Cushing Disease and Ectopic ACTH-Producing Tumors

  • Endocrine Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Bilateral adrenalectomy (BA) is a curative treatment for hypercortisolism in patients with corticotropin (ACTH)-dependent Cushing syndrome. Indications include refractory Cushing’s disease (CD) following failed pituitary surgery, and occult or unresectable ectopic ACTH-producing neoplasms (EA).

Methods

This was a single-center, retrospective review (1995–2017) of patients undergoing BA for CD or EA. Demographics, laboratory findings, and intraoperative and postoperative variables were analyzed.

Results

Of 137 patients, 83 (61%) had CD and 54 (39%) had EA; 87% of CD patients were female versus 46% of EA patients (p < 0.0001). Mean age at diagnosis was 40 ± 15 years for CD and 49 ± 18 years for EA (p = 0.004). Preoperative serum cortisol concentrations were higher in the EA cohort (63 ± 40 μg/dL) versus the CD cohort (33 ± 19 μg/dL) [p < 0.001], with no significant differences in serum ACTH. Time from diagnosis until adrenalectomy was 54 ± 69 months for CD versus 4 ± 13 for EA (p = 0.002). Most patients underwent minimally invasive surgery (MIS; 86% CD vs. 75% EA; p = 0.19). There was no difference between the rates of conversion to an open approach, intraoperative blood loss, or operative time between groups, and no difference between complications in CD versus EA (p = 1.0). Five-year survival was significantly shorter among the EA cohort (30% for EA vs. 80% for CD; p < 0.001).

Conclusion

Patients with EA presented with higher serum cortisol levels compared with patients with CD. EA patients were more likely to require intraoperative transfusion and postoperative intensive care. BA in patients with CD and EA can be performed safely in an MIS fashion, with similar morbidity; however, survival at 5 years was significantly less in the EA cohort.

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Acknowledgment

All research was produced at Mayo Clinic Rochester, Rochester, MN, USA.

Disclosures

Thomas Szabo Yamashita, Alaa Sada, Irina Bancos, William F Young, Benzon M Dy, David R Farley, Melanie L Lyden, Geoffrey B Thompson, and Travis J McKenzie report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Thomas Szabo Yamashita MD, Alaa Sada MD, Benzon M. Dy MD, David R. Farley MD, Melanie L. Lyden MD, Geoffrey B. Thompson MD & Travis J. McKenzie MD

  2. Department of Endocrinology, Mayo Clinic, Rochester, MN, USA

    Irina Bancos MD & William F. Young MD

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  1. Thomas Szabo Yamashita MD
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  2. Alaa Sada MD
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Correspondence to Travis J. McKenzie MD.

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Szabo Yamashita, T., Sada, A., Bancos, I. et al. Bilateral Adrenalectomy: Differences between Cushing Disease and Ectopic ACTH-Producing Tumors. Ann Surg Oncol 27, 3851–3857 (2020). https://doi.org/10.1245/s10434-020-08451-4

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  • DOI: https://doi.org/10.1245/s10434-020-08451-4

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