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Laparoscopic adrenalectomy in patients with subclinical Cushing syndrome

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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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Disclosures

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

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Authors and Affiliations

  1. 3rd Department of Surgery, “George Gennimatas” General Hospital of Athens, Athens, Greece

    Iraklis Perysinakis, Spyridon Avlonitis, Anastasia Katseli & George N. Zografos

  2. Department of Endocrinology, “George Gennimatas” General Hospital of Athens, Athens, Greece

    Chrisanthi Marakaki, Lambrini Papanastasiou & George Piaditis

  3. Endocrine Unit, 2nd Department of Internal Medicine, Attikon University Hospital, Athens University Medical School, Athens, Greece

    Evangeline Vassilatou

  4. 10 K. Ourani street, 15237, Athens, Greece

    George N. Zografos

Authors
  1. Iraklis Perysinakis
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  2. Chrisanthi Marakaki
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  3. Spyridon Avlonitis
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  4. Anastasia Katseli
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  5. Evangeline Vassilatou
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  6. Lambrini Papanastasiou
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  7. George Piaditis
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  8. George N. Zografos
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Corresponding author

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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  • DOI: https://doi.org/10.1007/s00464-012-2730-5

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