Outcome of adrenalectomy for subclinical hypercortisolism and Cushing syndrome
Background We compared operative and metabolic outcomes in patients with subclinical Cushing syndrome and Cushing syndrome caused by unilateral adrenal lesion, aiming to clarify the role of glucocorticoid replacement treatment in patients with subclinical Cushing syndrome after adrenalectomy. Method...
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| Veröffentlicht in: | Surgery 2017-01, Vol.161 (1), p.264-271 |
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| creator | Raffaelli, Marco, MD De Crea, Carmela, MD D'Amato, Gerardo, MD Gallucci, Pierpaolo, MD Lombardi, Celestino P., MD Bellantone, Rocco, MD |
| description | Background We compared operative and metabolic outcomes in patients with subclinical Cushing syndrome and Cushing syndrome caused by unilateral adrenal lesion, aiming to clarify the role of glucocorticoid replacement treatment in patients with subclinical Cushing syndrome after adrenalectomy. Methods The medical records of all the patients who underwent unilateral adrenalectomy for subclinical Cushing syndrome or Cushing syndrome were reviewed. Diagnostic criteria for subclinical Cushing syndrome were a pathologic dexamethasone suppression test plus 2 additional criteria. Results Twenty-nine patients with subclinical Cushing syndrome and 50 with Cushing syndrome were identified. No significant difference was found between patients with subclinical Cushing syndrome and Cushing syndrome regarding lesion size, operative time, and hospital stay. Two patients out of 29 with subclinical Cushing syndrome and 3 out of 50 patients with Cushing syndrome experienced Clavien-Dindo grade II complications ( P = .87). All the patients required postoperative glucocorticoid replacement that was discontinued within 6 months in 28 of the 29 patients with subclinical Cushing syndrome and in 3 out of 50 Cushing syndrome patients ( P |
| doi_str_mv | 10.1016/j.surg.2016.07.042 |
| format | Article |
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Methods The medical records of all the patients who underwent unilateral adrenalectomy for subclinical Cushing syndrome or Cushing syndrome were reviewed. Diagnostic criteria for subclinical Cushing syndrome were a pathologic dexamethasone suppression test plus 2 additional criteria. Results Twenty-nine patients with subclinical Cushing syndrome and 50 with Cushing syndrome were identified. No significant difference was found between patients with subclinical Cushing syndrome and Cushing syndrome regarding lesion size, operative time, and hospital stay. Two patients out of 29 with subclinical Cushing syndrome and 3 out of 50 patients with Cushing syndrome experienced Clavien-Dindo grade II complications ( P = .87). All the patients required postoperative glucocorticoid replacement that was discontinued within 6 months in 28 of the 29 patients with subclinical Cushing syndrome and in 3 out of 50 Cushing syndrome patients ( P < .005). At long-term follow-up, adrenalectomy significantly improved hypertension and diabetes in affected patients, with no differences between subclinical Cushing syndrome and Cushing syndrome. Hypercortisolism was resolved in all the cases. Conclusion Operative and metabolic outcomes of adrenalectomy are similar in subclinical Cushing syndrome and Cushing syndrome. Postoperative glucocorticoid replacement treatment is advisable in all patients with subclinical Cushing syndrome. Prolonged adrenal insufficiency is more frequent in Cushing syndrome patients.</description><identifier>ISSN: 0039-6060</identifier><identifier>EISSN: 1532-7361</identifier><identifier>DOI: 10.1016/j.surg.2016.07.042</identifier><identifier>PMID: 27865591</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adrenalectomy - methods ; Adult ; Aged ; Analysis of Variance ; Cohort Studies ; Cushing Syndrome - diagnosis ; Cushing Syndrome - drug therapy ; Cushing Syndrome - surgery ; Databases, Factual ; Female ; Follow-Up Studies ; Glucocorticoids - therapeutic use ; Humans ; Laparoscopy - methods ; Male ; Middle Aged ; Postoperative Care - methods ; Retrospective Studies ; Risk Assessment ; Severity of Illness Index ; Surgery ; Treatment Outcome</subject><ispartof>Surgery, 2017-01, Vol.161 (1), p.264-271</ispartof><rights>Elsevier Inc.</rights><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-98eb668e41279dc055158bf92c7e6d0b14fe7a99595c63a9398861fe7865f1963</citedby><cites>FETCH-LOGICAL-c411t-98eb668e41279dc055158bf92c7e6d0b14fe7a99595c63a9398861fe7865f1963</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.surg.2016.07.042$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27865591$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Raffaelli, Marco, MD</creatorcontrib><creatorcontrib>De Crea, Carmela, MD</creatorcontrib><creatorcontrib>D'Amato, Gerardo, MD</creatorcontrib><creatorcontrib>Gallucci, Pierpaolo, MD</creatorcontrib><creatorcontrib>Lombardi, Celestino P., MD</creatorcontrib><creatorcontrib>Bellantone, Rocco, MD</creatorcontrib><title>Outcome of adrenalectomy for subclinical hypercortisolism and Cushing syndrome</title><title>Surgery</title><addtitle>Surgery</addtitle><description>Background We compared operative and metabolic outcomes in patients with subclinical Cushing syndrome and Cushing syndrome caused by unilateral adrenal lesion, aiming to clarify the role of glucocorticoid replacement treatment in patients with subclinical Cushing syndrome after adrenalectomy. Methods The medical records of all the patients who underwent unilateral adrenalectomy for subclinical Cushing syndrome or Cushing syndrome were reviewed. Diagnostic criteria for subclinical Cushing syndrome were a pathologic dexamethasone suppression test plus 2 additional criteria. Results Twenty-nine patients with subclinical Cushing syndrome and 50 with Cushing syndrome were identified. No significant difference was found between patients with subclinical Cushing syndrome and Cushing syndrome regarding lesion size, operative time, and hospital stay. Two patients out of 29 with subclinical Cushing syndrome and 3 out of 50 patients with Cushing syndrome experienced Clavien-Dindo grade II complications ( P = .87). All the patients required postoperative glucocorticoid replacement that was discontinued within 6 months in 28 of the 29 patients with subclinical Cushing syndrome and in 3 out of 50 Cushing syndrome patients ( P < .005). At long-term follow-up, adrenalectomy significantly improved hypertension and diabetes in affected patients, with no differences between subclinical Cushing syndrome and Cushing syndrome. Hypercortisolism was resolved in all the cases. Conclusion Operative and metabolic outcomes of adrenalectomy are similar in subclinical Cushing syndrome and Cushing syndrome. Postoperative glucocorticoid replacement treatment is advisable in all patients with subclinical Cushing syndrome. Prolonged adrenal insufficiency is more frequent in Cushing syndrome patients.</description><subject>Adrenalectomy - methods</subject><subject>Adult</subject><subject>Aged</subject><subject>Analysis of Variance</subject><subject>Cohort Studies</subject><subject>Cushing Syndrome - diagnosis</subject><subject>Cushing Syndrome - drug therapy</subject><subject>Cushing Syndrome - surgery</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Glucocorticoids - therapeutic use</subject><subject>Humans</subject><subject>Laparoscopy - methods</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Postoperative Care - methods</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Severity of Illness Index</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><issn>0039-6060</issn><issn>1532-7361</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU9r3DAQxUVpSTZpvkAPxcde7I5kS5YgFMqSP4WQHJqehSyPE21tayPZAX_7yGzSQw85aRDvPWZ-j5AvFAoKVHzfFXEODwVLcwF1ARX7QDaUlyyvS0E_kg1AqXIBAo7JSYw7AFAVlUfkmNVScK7ohtzezZP1A2a-y0wbcDQ92skPS9b5kMW5sb0bnTV99rjsMVgfJhd97-KQmbHNtnN8dONDFpexDSnmM_nUmT7i2et7Sv5cXtxvr_Obu6tf2583ua0onXIlsRFCYkVZrVoLnFMum04xW6NooaFVh7VRiituRWlUqaQUNP2ltTuqRHlKvh1y98E_zRgnPbhose_NiH6OmsqK8UoBV0nKDlIbfIwBO70PbjBh0RT0ylHv9MpRrxw11DpxTKavr_lzM2D7z_IGLgnODwJMVz47DDpah6PF1oUEULfevZ__4z_7G-e_uGDc-TmkJtIdOjIN-vfa5FokFSVwWUH5AsAtmT0</recordid><startdate>20170101</startdate><enddate>20170101</enddate><creator>Raffaelli, Marco, MD</creator><creator>De Crea, Carmela, MD</creator><creator>D'Amato, Gerardo, MD</creator><creator>Gallucci, Pierpaolo, MD</creator><creator>Lombardi, Celestino P., MD</creator><creator>Bellantone, Rocco, MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170101</creationdate><title>Outcome of adrenalectomy for subclinical hypercortisolism and Cushing syndrome</title><author>Raffaelli, Marco, MD ; De Crea, Carmela, MD ; D'Amato, Gerardo, MD ; Gallucci, Pierpaolo, MD ; Lombardi, Celestino P., MD ; Bellantone, Rocco, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-98eb668e41279dc055158bf92c7e6d0b14fe7a99595c63a9398861fe7865f1963</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adrenalectomy - methods</topic><topic>Adult</topic><topic>Aged</topic><topic>Analysis of Variance</topic><topic>Cohort Studies</topic><topic>Cushing Syndrome - diagnosis</topic><topic>Cushing Syndrome - drug therapy</topic><topic>Cushing Syndrome - surgery</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Glucocorticoids - therapeutic use</topic><topic>Humans</topic><topic>Laparoscopy - methods</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Postoperative Care - methods</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Severity of Illness Index</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Raffaelli, Marco, MD</creatorcontrib><creatorcontrib>De Crea, Carmela, MD</creatorcontrib><creatorcontrib>D'Amato, Gerardo, MD</creatorcontrib><creatorcontrib>Gallucci, Pierpaolo, MD</creatorcontrib><creatorcontrib>Lombardi, Celestino P., MD</creatorcontrib><creatorcontrib>Bellantone, Rocco, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Raffaelli, Marco, MD</au><au>De Crea, Carmela, MD</au><au>D'Amato, Gerardo, MD</au><au>Gallucci, Pierpaolo, MD</au><au>Lombardi, Celestino P., MD</au><au>Bellantone, Rocco, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcome of adrenalectomy for subclinical hypercortisolism and Cushing syndrome</atitle><jtitle>Surgery</jtitle><addtitle>Surgery</addtitle><date>2017-01-01</date><risdate>2017</risdate><volume>161</volume><issue>1</issue><spage>264</spage><epage>271</epage><pages>264-271</pages><issn>0039-6060</issn><eissn>1532-7361</eissn><abstract>Background We compared operative and metabolic outcomes in patients with subclinical Cushing syndrome and Cushing syndrome caused by unilateral adrenal lesion, aiming to clarify the role of glucocorticoid replacement treatment in patients with subclinical Cushing syndrome after adrenalectomy. Methods The medical records of all the patients who underwent unilateral adrenalectomy for subclinical Cushing syndrome or Cushing syndrome were reviewed. Diagnostic criteria for subclinical Cushing syndrome were a pathologic dexamethasone suppression test plus 2 additional criteria. Results Twenty-nine patients with subclinical Cushing syndrome and 50 with Cushing syndrome were identified. No significant difference was found between patients with subclinical Cushing syndrome and Cushing syndrome regarding lesion size, operative time, and hospital stay. Two patients out of 29 with subclinical Cushing syndrome and 3 out of 50 patients with Cushing syndrome experienced Clavien-Dindo grade II complications ( P = .87). All the patients required postoperative glucocorticoid replacement that was discontinued within 6 months in 28 of the 29 patients with subclinical Cushing syndrome and in 3 out of 50 Cushing syndrome patients ( P < .005). At long-term follow-up, adrenalectomy significantly improved hypertension and diabetes in affected patients, with no differences between subclinical Cushing syndrome and Cushing syndrome. Hypercortisolism was resolved in all the cases. Conclusion Operative and metabolic outcomes of adrenalectomy are similar in subclinical Cushing syndrome and Cushing syndrome. Postoperative glucocorticoid replacement treatment is advisable in all patients with subclinical Cushing syndrome. Prolonged adrenal insufficiency is more frequent in Cushing syndrome patients.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27865591</pmid><doi>10.1016/j.surg.2016.07.042</doi><tpages>8</tpages></addata></record> |
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| subjects | Adrenalectomy - methods Adult Aged Analysis of Variance Cohort Studies Cushing Syndrome - diagnosis Cushing Syndrome - drug therapy Cushing Syndrome - surgery Databases, Factual Female Follow-Up Studies Glucocorticoids - therapeutic use Humans Laparoscopy - methods Male Middle Aged Postoperative Care - methods Retrospective Studies Risk Assessment Severity of Illness Index Surgery Treatment Outcome |
| title | Outcome of adrenalectomy for subclinical hypercortisolism and Cushing syndrome |
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