World Journal of Surgery

, Volume 32, Issue 5, pp 659–677 | Cite as

Surgery for Cushing’s Syndrome: An Historical Review and Recent Ten-year Experience

  • John R. Porterfield
  • Geoffrey B. ThompsonEmail author
  • William F. YoungJr.
  • John T. Chow
  • Raymond S. Fryrear
  • Jon A. van Heerden
  • David R. Farley
  • John L. D. Atkinson
  • Fredric B. Meyer
  • Charles F. Abboud
  • Todd B. Nippoldt
  • Neena Natt
  • Dana Erickson
  • Adrian Vella
  • Paul C. Carpenter
  • Melanie Richards
  • J. Aidan Carney
  • Dirk Larson
  • Cathy Schleck
  • Marilyn Churchward
  • Clive S. Grant



Cushing’s syndrome (CS), due to multiple etiologies, is a disorder associated with the ravages of cortisol excess. The purpose of this review article is to provide a historical synopsis of surgery for CS, review a recent 10-year period of operative management at a tertiary care facility, and to outline a practical approach to diagnosis and management.

Materials and Methods

From 1996 to 2005, 298 patients underwent 322 operative procedures for CS at Mayo Clinic, Rochester, Minnesota. A retrospective chart review was carried out. Data was gathered regarding demographics, preoperative assessment, procedures performed, and outcomes. Data are presented as counts and percentages. Five-year survival rates were calculated where applicable by the Kaplan-Meier method. Statistical analysis was carried out with SAS, version 9 (SAS Institute, Inc., Cary, NC).


Two-hundred thirty-one patients (78%) had ACTH-dependent CS and 67 patients (22%) had ACTH-independent CS. One-hundred ninety-six patients (66%) had pituitary-dependent CS and 35 patients (12%) had ectopic ACTH syndrome. Fifty-four patients (18%) had cortisol-secreting adenomas, 10 patients (3%) had cortisol-producing adrenocortical carcinomas, and 1% had other causes. Cure rates for first time pituitary operations (transsphenoidal, sublabial, and endonasal) were 80% and 55% for reoperations. Most benign adrenal processes could be managed laparoscopically. Five-year survival rates (all causes) were 90%, 51%, and 23% for adrenocortical adenomas, ectopic ACTH syndrome, and adrenocortical carcinomas, respectively.


Surgery for CS is highly successful for pituitary-dependent CS and most ACTH-independent adrenal causes. Bilateral total adrenalectomy can also provide effective palliation from the ravages of hypercortisolism in patients with ectopic ACTH syndrome and for those who have failed transsphenoidal surgery. Unfortunately, to date, adrenocortical carcinomas are rarely cured. Future successes with this disease will likely depend on a better understanding of tumor biology, more effective adjuvant therapies and earlier detection. Clearly, IPSS, advances in cross-sectional imaging, along with developments in transsphenoidal and laparoscopic surgery, have had the greatest impact on today’s management of the complex patient with CS.


Adrenocortical Carcinoma Mitotane Adrenal Incidentalomas Ectopic ACTH Syndrome Inferior Petrosal Sinus Sampling 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Harris DA, Wheeler MH (2005) History of adrenal surgery. In: Linos D, van Heerden JA (eds) Adrenal Glands. Springer-Verlag, Heidelberg, p. 1–6Google Scholar
  2. 2.
    Eustachii B. Opuscula Anatomica. Quoted by Harrison TS, Gann DS, Edis AJ et al. (1975) Surgical disorders of the adrenal gland, New York, Grune & Stratton, 1–2Google Scholar
  3. 3.
    Addison T (1855) On the constitutional and local effects of disease of the suprarenal capsules. S. Highley, LondonGoogle Scholar
  4. 4.
    Trousseau A (1856) Bronze Addison’s disease. Arch Gen Med 8:478Google Scholar
  5. 5.
    Brown-Séquard E (1856) Recherches éxperimentales sur la physiologie et la pathologie des capsules surrenals. Arch Gen Med (Paris) 8:385–401Google Scholar
  6. 6.
    Osler W (1896) Six cases of Addison’s disease. Int Med Mag 5:3–11Google Scholar
  7. 7.
    Abel JJ, Crawford AC (1897) On the blood-pressure raising constituent of the suprarenal capsule. Johns Hopkins Hosp Bull 8:151–157Google Scholar
  8. 8.
    Rolleston HD (1936) The endocrine organs in health and disease, with a historical review. Oxford University Press, London, p. 355Google Scholar
  9. 9.
    Kendall EC, Mason HL, Myers CSA et al. (1936) A physiological and chemical investigation of the suprarenal cortex. J Biol Chem 114:57–58Google Scholar
  10. 10.
    Reichstein T (1936) Constituents of the adrenal cortex. Helv Chiim Acta 19:402–412Google Scholar
  11. 11.
    Simpson SA, Tait JF, Bush JE (1952) Secretion of a salt retaining hormone by the mammalian adrenal cortex. Lancet 2:226–2232PubMedGoogle Scholar
  12. 12.
    Cahill GF (1935) Air injections to demonstrate the adrenals by x-ray. J Urol 34:238–243Google Scholar
  13. 13.
    Melby JC, Spark FF, Dale SL et al. (1967) Diagnosis and localization of aldosterone producing adenomas by adrenal vein catheterization. N Engl J Med 277:1050–1056PubMedCrossRefGoogle Scholar
  14. 14.
    Adamson U, Efendic S, Granberg PO et al. (1980) Preoperative localization of aldosterone-producing adenomas. An analysis of the efficiency of different diagnostic procedures made from 11 cases and from a review of the literature. Acta Med Scand 208:101–109PubMedCrossRefGoogle Scholar
  15. 15.
    Thrall JH, Freitas JE, Beierwaltes WH (1978) Adrenal scintigraphy. Semin Nucl Med 23–41Google Scholar
  16. 16.
    Sheedy PF, Stephens DH, Hattery RR et al. (1976) Computed tomography of the body: initial clinical trials with the EMI prototype. Am J Roentgenol 127:23–51Google Scholar
  17. 17.
    Thornton JK (1890) Abdominal nephrectomy for large sarcoma of the left suprarenal capsule: recovery. Trans Clin Soc Lond 23:150–153Google Scholar
  18. 18.
    Cushing H (1932) The basophil adenomas of the pituitary body and their clinical manifestations (pituitary basophilism). Johns Hopkins Hosp Bull 50:137–195Google Scholar
  19. 19.
    Schloffer H (1907) Erfolgreiche operation eines hypophysentumors and nasalem wege. Wien Klin Wochenschr 20:621–624Google Scholar
  20. 20.
    Cushing H (1909) Partial hypophysectomy for acromegaly. With remarks on the function of the hypophysis. Ann Surg 50:1002–1017PubMedGoogle Scholar
  21. 21.
    Cohen-Gadol AA, Liu JK, Laws ER Jr (2005) Cushing’s first case of transsphenoidal surgery: the launch of the pituitary surgery era. J Neurosurg 103:570–574PubMedCrossRefGoogle Scholar
  22. 22.
    Fulton JF (1946) Harvey Cushing: A Biography. Charles C Thomas, Springfield, ILGoogle Scholar
  23. 23.
    Halstead AE (1910) Remarks on the operative treatment of tumors of the hypophysis. With the report of two cases operated on by an oronasal method. Surg Gynecol Obstet 10:494–502Google Scholar
  24. 24.
    Walters W, Wilder RM, Kepler EJ (1934) The suprarenal cortical syndrome. Ann Surg 100:670–688PubMedGoogle Scholar
  25. 25.
    Priestley JT, Sprague RG, Walters W et al. (1951) Subtotal adrenalectomy for Cushing’s syndrome. Ann Surg 134:464–475PubMedGoogle Scholar
  26. 26.
    von Langenbüch C (1882) Ein fall von exstirpation der gallenblase. Berlin Klin Wochenschr 19:725–727. Quoted by Welbourn RB in The History of Endocrine Surgery, London, Praeger, 1990, p. 151Google Scholar
  27. 27.
    Broster LR, Hill HG, Greenfield JG (1932) Adreno-genital syndrome and unilateral adrenalectomy. Br J Surg 19:557–570Google Scholar
  28. 28.
    Mayo CH (1927) Paroxysmal hypertension with tumour of retroperitoneal nerve. JAMA 89:1047–1050Google Scholar
  29. 29.
    Young HH (1936) Technique for simultaneous exposure and operation on the adrenals. Surg Gynecol Obstet 63:179–188Google Scholar
  30. 30.
    Russell CF, Hamberger B, van Heerden JA et al. (1982) Adrenalectomy: anterior or posterior approach? Am J Surg 144:322–324PubMedGoogle Scholar
  31. 31.
    Gagner M, Lacrois A, Bolte E (1992) Laparoscopic adrenalectomy in Cushing’s syndrome and phaeochromocytoma. N Engl J Med 327:1033PubMedCrossRefGoogle Scholar
  32. 32.
    Thompson GB, Grant CS, van Heerden JA et al. (1997) Laparoscopic versus open posterior adrenalectomy: a case-control study of 100 patients. Surgery 122:1132–1136PubMedGoogle Scholar
  33. 33.
    Lal G, Duh QY (2003) Laparoscopic adrenalectomy—indications and technique. Surg Oncol 12:105–123PubMedGoogle Scholar
  34. 34.
    Micali S, Peluso G, De Stefani S et al. (2005) Laparoscopic adrenal surgery: new frontiers. J Endourol 19:272–278PubMedGoogle Scholar
  35. 35.
    Porpiglia F, Fiori C, Bovio S et al. (2004) Bilateral adrenalectomy for Cushing’s syndrome: a comparison between laparoscopic and open surgery. J Endocrinol Invest 27:654–658PubMedGoogle Scholar
  36. 36.
    Saunders BD, Wainess RM, Dimick JB et al. (2004) Trends in utilization of adrenalectomy in the United States: have indications changed? World J Surg 28:1169–1175PubMedGoogle Scholar
  37. 37.
    Naya Y, Suzuki H, Komiya A et al. (2005) Laparoscopic adrenalectomy in patients with large adrenal tumors. Int J Urol 12:134–139PubMedGoogle Scholar
  38. 38.
    Chavez-Rodriguez J, Pasieka JL (2005) Adrenal lesions assessed in the era of laparoscopic adrenalectomy: a modern day series. Am J Surg 189:581–585PubMedGoogle Scholar
  39. 39.
    Hara I, Kawabata G, Hara S et al. (2005) Clinical outcomes of laparoscopic adrenalectomy according to tumor size. Int J Urol 12:1015–1021Google Scholar
  40. 40.
    Gumbs AA, Gagner M (2006) Laparoscopic adrenalectomy. Best Clin Pract Res Clin Endocrinol Metab 20:483–499Google Scholar
  41. 41.
    Young WF Jr, Thompson GB (2005) Laparoscopic adrenalectomy for patients who have Cushing’s syndrome. Endocrinol Metab Clin North Am 34:489–499PubMedGoogle Scholar
  42. 42.
    Mercan S, Seven R, Ozarmagan S et al. (1995) Endoscopic retroperitoneal adrenalectomy. Surgery 118:1071–1075PubMedGoogle Scholar
  43. 43.
    Walz MK, Alesina PF, Wenger FA et al. (2006) Posterior retroperitoneoscopic adrenalectomy—results of 560 procedures in 520 patients. Surgery 140:943–950PubMedGoogle Scholar
  44. 44.
    Barczyski M, Konturek A, Golkowski F et al. (2007) Posterior retroperitoneoscopic adrenalectomy: a comparison between the initial experience in the invention phase and introductory phase of the new surgical technique. World J Surg 31:65–71Google Scholar
  45. 45.
    Jacobson L (2005) Hypothalamic-pituitary-adrenocortical axis regulation. Endocrinol Metab Clin North Am 34:271–292PubMedGoogle Scholar
  46. 46.
    Stewart PM (2003) The adrenal cortex. In: Larsen PR, Knonenberg HM, Melmed S, Polansky KS (eds) Williams Textbook of Endocrinology, Tenth Edition. Saunders, Philadelphia, pp. 491–548Google Scholar
  47. 47.
    Arlt W, Stewart PM (2005) Adrenal corticosteroid biosynthesis, metabolism, and action. Endocrinol Metab Clin North Am 34:293–313PubMedGoogle Scholar
  48. 48.
    Findling JW, Raff H (2005) Screening and diagnosis of Cushing’s syndrome. Endocrinol Metab Clin North Am 34:385–402PubMedGoogle Scholar
  49. 49.
    Carpenter PC (1998) Cushing’s syndrome. In: Rakel RE (ed) Conn’s Current Therapy. WB Saunders, Phildelphia, pp. 616–620Google Scholar
  50. 50.
    Cushing H (1912) The Pituitary Body and its Disorders: Clinical Status Produced by Disorders of the Hypophysis Cerebri. JB Lippincott, PhiladelphiaGoogle Scholar
  51. 51.
    Meador CK, Liddle GW, Island DP et al. (1962) Cause of Cushing’s syndrome in patients with tumors arising from “nonendocrine” tissue. J Clin Endocrinol Metab 22:693–703PubMedGoogle Scholar
  52. 52.
    Lindsay JR, Nieman LK (2005) Differential diagnosis and imaging in Cushing’s syndrome. Endocrinol Metab Clin North Am 34:403–421PubMedGoogle Scholar
  53. 53.
    Aniszewski JP, Young WF Jr, Thompson GB et al. (2001) Cushing syndrome due to ectopic adrenocorticotropic hormone secretion. World J Surg 25:934–940PubMedGoogle Scholar
  54. 54.
    Vrezas I, Willenberg HS, Mansmann G et al. (2003) Ectopic adrenocorticotropin (ACTH) and corticotropin-releasing hormone (CRH) production in the adrenal gland: basic and clinical aspects. Microsc Res Tech 61:308–314PubMedGoogle Scholar
  55. 55.
    Hérnandez I, Ispinosa-de-los-Monteros AL, Mendoza V et al. (2006) Ectopic ACTH-secreting syndrome: a single center experience report with a high prevalence of occult tumor. Arch Med Res 37:976–980PubMedGoogle Scholar
  56. 56.
    Kendrick ML, Lloyd R, Erickson L et al. (2001) Adrenocortical carcinoma: surgical progress or status quo? Arch Surg 136:543–549PubMedGoogle Scholar
  57. 57.
    Icard P, Chapuis Y, Andreassian B et al. (1992) Adrenocortical carcinoma in surgically treated patients. A retrospective study on 156 cases by the French Association of Endocrine Surgery. Surgery 112:9792Google Scholar
  58. 58.
    Lacroix A, Bourdeau I (2005) Bilateral adrenal Cushing’s syndrome: macronodular adrenal hyperplasia and primary pigmented nodular adrenocortical disease. Endocrinol Metab Clin North Am 34:441–458PubMedGoogle Scholar
  59. 59.
    Young WF Jr (2007) The incidentally discovered adrenal mass. N Engl J Med 356:601–610PubMedGoogle Scholar
  60. 60.
    Barzon L, Sonino N, Fallo F et al. (2003) Prevalence and natural history of adrenal incidentalomas. Eur J Endocrinol 149:273–285PubMedGoogle Scholar
  61. 61.
    Tsagarakis S, Vassiliadi D, Thalassinos N (2006) Endogenous subclinical hypercortisolism: diagnostic uncertainties and clinical implications. J Endocrinol Invest 29:471–482PubMedGoogle Scholar
  62. 62.
    Sippel RS, Chen H (2004) Subclinical Cushing’s syndrome in adrenal incidentaloma. Surg Clin North Am 84:875–885PubMedGoogle Scholar
  63. 63.
    Terzolo M, Bovio S, Reimondo G et al. (2005) Subclinical Cushing’s syndrome in adrenal incidentalomas. Endocrinol Metab Clin North Am 34:423–439PubMedGoogle Scholar
  64. 64.
    Izaki H, Fukumori T, Takahashi M et al. (2006) Indications for laparoscopic adrenalectomy for non-functional adrenal tumor with hypertension: usefulness of adrenocortical scintigraphy. Int J Urol 13:677–681PubMedGoogle Scholar
  65. 65.
    Midorikawa S, Sanada H, Hashimoto S et al. (2001) The improvement of insulin resistance in patients with adrenal incidentaloma by surgical resection. Clin. Endocrinol. 54:797–804Google Scholar
  66. 66.
    Young WF Jr, Carney JA, Musa BU et al. (1989) Familial Cushing’s syndrome due to primary pigmented nodular adrenocortical disease: reinvestigation 50 years later. N Engl J Med 321:1659–1664PubMedCrossRefGoogle Scholar
  67. 67.
    Lacroix A, Baldacchino V, Bourdeau I et al. Cushing’s syndrome variants secondary to aberrant hormone receptors. Trends Endocrinol Metab 15:375–382Google Scholar
  68. 68.
    Christopoulos S, Bourdeau I, Lacroix A (2004) Aberrant expression of hormone receptors in adrenal Cushing’s syndrome. Pituitary 7:231–241Google Scholar
  69. 69.
    Swain JM, Grant CS, Schlinkert RT et al. (1998) Corticotropin-independent macronodular adrenal hyperplasia. A clinicopathologic correlation. Arch Surg 133:541–546PubMedGoogle Scholar
  70. 70.
    Storr HL, Mitchell H, Swords FM et al. (2004) Clinical features, diagnosis, treatment, and molecular studies in paediatric Cushing’s syndrome due to primary nodular adrenocortical hyperplasia. Clin Endocrinol 61:553–559Google Scholar
  71. 71.
    Gunther DF, Bourdeau I, Matyakhina L et al. (2004) Cyclical Cushing’s syndrome presenting in infancy: an early form of primary pigmented nodular adrenocortical disease, or a new entity? J Clin Endocrinol Metab 89:3173–3182PubMedGoogle Scholar
  72. 72.
    Contreras LN, Cardosa E, Lozano MP et al. (2000) Detection of preclinical Cushing’s syndrome in overweight type 2 diabetic patients. Medicina 60:326–330PubMedGoogle Scholar
  73. 73.
    Davies JS, Ogunko A, Smith J et al. (2000) Diagnostic dilemmas in Cushing’s syndrome. Ann Clin Biochem 37:85–89PubMedGoogle Scholar
  74. 74.
    Newell-Price J, Bertagna X, Grossman AB et al. (2006) Cushing’s syndrome. Lancet 367:1605–1617PubMedGoogle Scholar
  75. 75.
    Lin DD, Loughlin KR (2005) Diagnosis and management of surgical adrenal disease. Urology 66:476–483PubMedGoogle Scholar
  76. 76.
    Nieman LK, Ilias I (2005) Evaluation and treatment of Cushing’s syndrome. Am J Med 118:1340–1346PubMedGoogle Scholar
  77. 77.
    Arnaldi G, Angeli A, Atkinson AB et al. (2003) Diagnosis and complications of Cushing’s syndrome: a consensus statement. J Clin Endocrinol Metab 88:5593–5602PubMedGoogle Scholar
  78. 78.
    Raff H, Findling JW (2003) A physiologic approach to diagnosis of the Cushing syndrome. Ann Intern Med 138:980–991PubMedGoogle Scholar
  79. 79.
    Simard M (2004) The biochemical investigation of Cushing syndrome. Neurosurg Focus 16:1–5Google Scholar
  80. 80.
    Nieman LK, Cutler GB Jr (1999) The sensitivity of the urine-free cortisol measurement as a screening test for Cushing’s syndrome. In Program and Abstracts of the 72nd Annual Meeting of the Endocrine Society, Atlanta, Georgia, June, p. 230Google Scholar
  81. 81.
    Puig J, Wagner A, Caballero A et al. (1999) Cost-effectiveness and accuracy of the tests used in the differential diagnosis of Cushing’s. Pituitary 1:125–132PubMedGoogle Scholar
  82. 82.
    Raff H, Raff JL, Findling JW (1998) Late-night salivary cortisol as a screening test for Cushing’s syndrome. J Clin Endocrinol Metab 83:2681–2686PubMedGoogle Scholar
  83. 83.
    Lindsay JR, Nieman LK (2005) Differential diagnosis and imaging in Cushing’s syndrome. Endocrinol. Metab Clin North Am 34:403–421PubMedGoogle Scholar
  84. 84.
    Yanovski JA, Cutler GB Jr, Chrousos GP et al. (1993) Corticotropin-releasing hormone stimulation following low-dose dexamethasone administration. JAMA 269:2232–2238PubMedGoogle Scholar
  85. 85.
    Rockall AG, Babar SA, Sohaib SA et al. (2004) CT and MR imaging of the adrenal glands in ACTH-independent Cushing’s syndrome. Radiographics 24:435–452PubMedGoogle Scholar
  86. 86.
    Korobkin M, Brodeur FJ, Yutzy GG et al. (1996) Differentiation of adrenal adenomas from nonadenomas using CT attenuation values. Am J Roentgenol 166:531–536Google Scholar
  87. 87.
    Findling JW, Kehoe ME, Shaker JL et al. (1991) Routine inferior petrosal sinus sampling in the differential diagnosis of adrenocorticotropin (ACTH)-dependent Cushing’s syndrome: early recognition of the occult ectopic ACTH syndrome. J Clin Endocdrinol Metab 73:408–413Google Scholar
  88. 88.
    Oldfield EH, Doppman JL, Nieman LK et al. (1991) Petrosal sinus sampling with and without corticotropoin-releasing hormone for the differential diagnosis of Cushing’s syndrome. N Engl J Med 325:897–905PubMedCrossRefGoogle Scholar
  89. 89.
    Bonelli FS, Huston J III, Carpenter PC et al. (2000) Adrenocorticotropic hormone-dependent Cushing’s syndrome: sensitivity and specificity of inferior petrosal sinus sampling. AJNR Am. J Neuroradiol 21:690–696PubMedGoogle Scholar
  90. 90.
    Obuobie K, Davies JS, Ogunko A et al. (2002) Venous thrombo-embolism following inferior petrosal sinus sampling in Cushing’s disease. J Endocrinol Invest 3:542–544Google Scholar
  91. 91.
    Lefournier V, Gatta B, Martinie M et al. (1999) One transient neurological complication (sixth nerve palsy) in 166 consecutive inferior petrosal sinus sampling for the etiological diagnosis of Cushing’s syndrome. J Clin Endocrinol Metab 84:3401–3402PubMedGoogle Scholar
  92. 92.
    Sturrock ND, Jeffcoate WJ (1997) A neurological complication of inferior petrosal sinus sampling during investigation for Cushing’s disease: a case report. J. Neurol. Neurosurg. Psychiatry 62:527–528PubMedGoogle Scholar
  93. 93.
    Miller DL, Doppman JL, Peterman SB et al. (1999) Neurological complications of petrosal sinus sampling. Radiology 185:143–147Google Scholar
  94. 94.
    Kaltsas GA, Giannulis MG, Newell-Price JD et al. (1999) A critical analysis of the value of simultaneous inferior petrosal sinus sampling in Cushing’s disease and the occult ectopic adrenocorticotropin syndrome. J Clin Endocrinol Metab 84:487–492PubMedGoogle Scholar
  95. 95.
    Doppman JL, Chang R, Oldfield EH et al. (1999) The hypoplastic inferior petrosal sinus: a potential source of false-negative results in petrosal sampling for Cushing’s disease. J Clin Endocrinol Metab 84:533–540PubMedGoogle Scholar
  96. 96.
    Lienhardt A, Grossman AB, Dacie JE et al. (2001) Relative contributions of inferior petrosal sinus sampling and pituitary imaging in the investigation of children and adolescents with ACTH-dependent Cushing’s syndrome. J Clin Endocrinol Metab 86:5711–5714PubMedGoogle Scholar
  97. 97.
    Tabarin A, Vallil N, Chanson P et al. (1999) Usefulness of somatostatin receptor scintigraphy in patients with occult ectopic adrenocorticotropin syndrome. J Clin Endocrinol Metab 84:1193–1202PubMedGoogle Scholar
  98. 98.
    Granberg D, Sundin A, Janson ET et al. (2003) Octreoscan in patients with bronchial carcinoid tumours. Clin Endocrinol (Oxf) 59:793–799Google Scholar
  99. 99.
    Catargi B, Rigalleau V, Poussin A et al. (2003) Occult Cushing’s syndrome in type II diabetes. J Clin Endocrinol Metab 88:5808–5813PubMedGoogle Scholar
  100. 100.
    Markou A, Manning P, Kaya B et al. (2005) [18F]fluoro-2-deoxy-d-glucose ([18F]FDG) positron emission tomography imaging of thymic carcinoid tumor presenting with recurrent Cushing’s syndrome. Eur J Endocrinol 152:521–525PubMedGoogle Scholar
  101. 101.
    Utz AL, Swearingen B, Biller BMK (2005) Pituitary surgery and postoperative management in Cushing’s disease. Endocrinol Metab Clin North Am 34:459–478PubMedGoogle Scholar
  102. 102.
    Guilhaume B, Bertagna X, Thomsen M et al. (1988) Transsphenoidal pituitary surgery for the treatment of Cushing’s disease: results in 64 patients and long term follow-up studies. J Clin Endocrinol Metab 66:1056–1064PubMedCrossRefGoogle Scholar
  103. 103.
    Arnott RD, Pestell RG, McKelvie PA et al. (1999) A critical evaluation of transsphenoidal pituitary surgery in the treatment of Cushing’s disease: prediction of outcome. Acta Endocrinol (Copenh) 123:423–430Google Scholar
  104. 104.
    Pieters GFFM, Hermus ARMM, Meijer E et al. (1989) Predictive factors for initial cure and relapse rate after pituitary surgery for Cushing’s disease. J Clin Endocriniol Metab 69:1122–1126Google Scholar
  105. 105.
    Graham KE, Samuels MH, Raff H et al. (1997) Intraoperative adrenocorticotropin levels during transsphenoidal surgery for Cushing’s disease do not predict cure. J Clin Endocrinol Metab 82:1776–1779PubMedGoogle Scholar
  106. 106.
    Semple CG, Thomson JA, Teasdale GM Transsphenoidal surgery for Cushing’s disease. Clin Endocrinol (Oxf) 21:621–629Google Scholar
  107. 107.
    Friedman RB, Oldfield EH, Nieman LK et al. (1989) Repeat transsphenoidal surgery for Cushing’s disease. J Neurosurg 71:520–527PubMedGoogle Scholar
  108. 108.
    Laws ER, Reigmeyer M, Thapar K et al. (2002) Cushing’s disease resulting from pituitary corticotrophic microadenoma. Treatment results from transsphenoidal microsurgery and gamma knife radiosurgery. Neuro-Chir 48:294–299Google Scholar
  109. 109.
    Leinung MC, Kane LA, Scheithauer BW et al. (1995) Long term follow-up of transsphenoidal surgery for the treatment of Cushing’s disease in childhood. J Clin Endocrinol Metab 80:2475–2479PubMedGoogle Scholar
  110. 110.
    Nasseri SS, Kasperbauer JL, Strome SE et al. (2001) Endoscopic transnasal pituitary surgery: report of 180 cases. Am J Rhinol 15:281–287PubMedGoogle Scholar
  111. 111.
    Chow JT, Thompson GB, Grant CS et al. (2007) Bilateral laparoscopic adrenalectomy for ACTH-dependent Cushing’s syndrome. Clin Endocrinol In Press, Available online from 29 October 2007Google Scholar
  112. 112.
    Vella A, Thompson GB, Grant CS et al. (1998) Laparoscopic adrenalectomy for adrenocorticotropin-dependent Cushing’s syndrome. J Clin Endocrinol Metab 83:348–352Google Scholar
  113. 113.
    Lairmore TC, Ball DW, Baylin SB et al. (1993) Management of pheochromocytomas in patients with multiple endocrine neoplasia type 2 syndrome. Ann Surg 217:595–601PubMedGoogle Scholar
  114. 114.
    Aniszewski JP, Sawka AM, Young WF Jr.(1999) Nelson-Salassa syndrome: a long-term follow-up study. 81st Annual Meeting of the Endocrine Society, San Diego, CA, June 15, p. 21 Google Scholar
  115. 115.
    Assie G, Bahurel H, Bertherat J et al. (2004) The Nelson’s syndrome ... revisted. Pituitary 7:209–215PubMedGoogle Scholar
  116. 116.
    Gil-Cardenas A, Herrera MF, Diaz-Polanco A et al. (2007) Nelson’s syndrome after bilateral adrenalectomy for Cushing’s disease. Surgery 141:147–151PubMedGoogle Scholar
  117. 117.
    Plowman PN (1994) Pituitary adenoma radiotherapy—when, who, and how? Clin Endocrinol (Oxf) 51:265–271Google Scholar
  118. 118.
    Hentschel SJ, McCutcheon IE (2004) Stereotactic radiosurgery for Cushing disease. Neurosurg. Focus 16:1–7Google Scholar
  119. 119.
    Voges J, Kocher m, Runge M et al. (2006) Linear accelerator radiosurgery for pituitary macroadenomas: a 7-year follow-up study. Cancer 107:1355–1364Google Scholar
  120. 120.
    Hellman P, Linder F, Hennings J et al. (2006) Bilateral adrenalectomy for ectopic Cushing’s syndrome—discussions on technique and indication. World J Surg 30:909–916PubMedGoogle Scholar
  121. 121.
    Kollmorgen CF, Thompson GB, Grant CS et al. (1998) Laparoscopic versus open posterior adrenalectomy: comparison of acute-phase response and wound healing in the cushingoid porcine model. World J Surg 22:613–619PubMedGoogle Scholar
  122. 122.
    Walz MK (2004) Extent of adrenalectomy for adrenal neoplasm: cortical sparing (subtotal) versus total adrenalectomy. Surg Clin North Am 84:743–753PubMedGoogle Scholar
  123. 123.
    Inoue T, Ishiguro K, Suda T et al. (2006) Laparoscopic bilateral partial adrenalectomy for adrenocortical adenomas causing Cushing’s syndrome: report of a case. Surg Today 36:94–97PubMedGoogle Scholar
  124. 124.
    Shen WT, Sturgeon C, Duh Q-Y (2005) From incidentaloma to adrenocortical carcinoma: the surgical management of adrenal tumors. J Surg Oncol 89:186–192PubMedGoogle Scholar
  125. 125.
    Sturgeon C, Kebebew E (2004) Laparoscopic adrenalectomy for malignancy. Surg Clin North Am 84:755–774PubMedGoogle Scholar
  126. 126.
    Schulick RD, Brennan MF (1999) Long-term survival after complete resection and repeat resection in patients with adrenocortical carcinoma. Ann Surg Oncol 6:719–726PubMedGoogle Scholar
  127. 127.
    Ritchey M, Kinard R, Novicki DE (1987) Adrenal tumors: involvement of the inferior vena cava. J Urol 138:1134PubMedGoogle Scholar
  128. 128.
    Terzolo M, Angeli A, Fassnacht M et al. (2000) Adjuvant mitotane treatment for adrenocortical carcinoma. N Engl J Med 356:2372–2380Google Scholar
  129. 129.
    Schteingart DE, Doherty GM, Gauger PG et al. (2005) Management of patients with adrenal cancer: recommendations of an international consensus conference. Endocr-Rel Cancer 12:667–680Google Scholar
  130. 130.
    Berruti A, Terzolo M, Pia A et al. (1998) Mitotane associated with etoposide, doxorubicin and cisplatin in the treatment of advanced adrenocortical carcinoma. Italian Group for the Study of Adrenal Cancer. Cancer 83:2194–2200PubMedGoogle Scholar
  131. 131.
    Figueiredo BC, Stratakis CA, Sandrini R et al. (1999) Comparative genomic hybridization analysis of adrenocortical tumors in childhood. J Clin Endocrinol Metab 84:1116–1121PubMedGoogle Scholar
  132. 132.
    Khan TS, Imam H, Juhlin C (2000) Streptozocin and o,p’-DDD in the treatment of adrenocortical cancer patients: long term survival in its adjuvant use. Ann Oncol 11:1281–1287PubMedGoogle Scholar
  133. 133.
    Schteingart DE, Homan D (2001) Management of adrenal cancer. In: Margioris AN, Chrousos G (eds) Adrenal Disorders. Humana Press, Totowa, p. 231–247Google Scholar
  134. 134.
    Wajchenberg B, Albergaria PM, Medonca B et al. (2000) Adrenocortical carcinoma: clinical and laboratory observations. Cancer 88:711–736PubMedGoogle Scholar
  135. 135.
    Williamsom SK, Lew D, Miller GJ et al. (2000) Phase II evaluation of cisplatin and etoposide followed by mitotane at disease progression in patients with locally advanced or metastatic adrenocortical carcinoma. A Southwestern Oncology Study. Cancer 88:1159–1165Google Scholar
  136. 136.
    Riedl M, Maier C, Zetting G et al. (2006) Long term control of hypercortisolism with fluconazole: case report and in vitro studies. Eur J Endocrinol 154:519–524PubMedGoogle Scholar
  137. 137.
    Heaney AP (2004) PPAR-γ in Cushing’s disease. Pituitary 7:265–269PubMedGoogle Scholar
  138. 138.
    Greening JE, Brain CE, Perry LA et al. (2005) Efficient short-term control of hypercortisolaemia by low-dose etomidate in severe paediatric Cushing’s disease. Horm Res 64:140–143PubMedGoogle Scholar
  139. 139.
    Lindsay JR, Nieman LK (2005) The hypothalamic-pituitary-adrenal axis in pregnancy: challenges in disease detection and treatment. Endocrinol Rev 26:775–799Google Scholar

Copyright information

© Société Internationale de Chirurgie 2007

Authors and Affiliations

  • John R. Porterfield
    • 1
  • Geoffrey B. Thompson
    • 1
    Email author
  • William F. YoungJr.
    • 2
  • John T. Chow
    • 2
  • Raymond S. Fryrear
    • 1
  • Jon A. van Heerden
    • 1
  • David R. Farley
    • 1
  • John L. D. Atkinson
    • 3
  • Fredric B. Meyer
    • 3
  • Charles F. Abboud
    • 2
  • Todd B. Nippoldt
    • 2
  • Neena Natt
    • 2
  • Dana Erickson
    • 2
  • Adrian Vella
    • 2
  • Paul C. Carpenter
    • 2
  • Melanie Richards
    • 1
  • J. Aidan Carney
    • 5
  • Dirk Larson
    • 4
  • Cathy Schleck
    • 4
  • Marilyn Churchward
    • 1
  • Clive S. Grant
    • 1
  1. 1.Department of SurgeryMayo Clinic and Mayo FoundationRochesterUSA
  2. 2.Division of Endocrinology, Diabetes, Metabolism, and NutritionMayo Clinic and Mayo FoundationRochesterUSA
  3. 3.Department of Neurologic SurgeryMayo Clinic and Mayo FoundationRochesterUSA
  4. 4.Department of Health Sciences ResearchMayo Clinic and Mayo FoundationRochesterUSA
  5. 5.Department of Laboratory Medicine and PathologyMayo Clinic and Mayo FoundationRochesterUSA

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