Results of adrenal surgery for cushing's syndrome: 10 Years' experience

Eighty‐nine patients underwent adrenal exploration for Cushing's syndrome at our institution during the period 1970–1979. On the basis of clinical and histological findings related to the initial adrenal operation, patients were divided into 6 major subgroups: (a) adrenocortical adenoma; (b) adrenocortical carcinoma; (c) proven ectopic ACTH adrenocortical hyperplasia; (d) Cushing's disease; (e) uncertain diagnostic group (probably ectopic ACTH syndrome—site unknown); and (f) “non‐ACTH‐dependent” hypercortisolism due to micronodular hyperplasia. Results of pathologic examination included 25 adrenal adenomas, 15 adrenocortical carcinomas, 40 bilateral adrenocortical hyperplasias, and a single case of micronodular hyperplasia. The postoperative mortality rate was 5.6%, and significant morbidity occurred in 40% of patients. Four of the 5 patients who died within 30 days of operation were in the subgroups with adrenal carcinoma (2 patients) and Cushing's disease (2 patients). Survival in patients with adrenocortical adenomas was significantly decreased at 2 years (relative adrenocortical insufficiency?), but thereafter, it paralleled the expected survival. Patients with the ectopic ACTH syndrome and adrenocortical carcinoma had significantly decreased survival, with only one‐third of carcinoma patients alive 2 years postoperatively. The survival of patients with Cushing's disease was lower than expected at both 5 and 10 years. These results confirm that the diagnosis of patients with endogenous hypercortisolism is usually straightforward and accurate, surgical intervention in this group of patients is still accompanied by significant short‐term mortality and morbidity, and long‐term survival in all subgroups is decreased. Résumé De 1970 à 1979 les auteurs ont procédé à une exploration surrénalienne chez 89 malades qui présentaient un syndrome de Cushing. Sur la base des données cliniques et histologiques ils ont individualisé 6 groupes: (a) adénome cortico‐surrénalien; (b) cancer cortico‐surrénalien; (c) hyperplasie cortico‐surrénalienne ACTH ectopique d'origine prouvée; (d) maladie de Cushing; (e) groupe de diagnostic incertain (probablement syndrome ACTH ectopique de site inconnu); et (f) hypercortisolisme—non ACTH dépendant due à une hyperplasie micronodulaire. Les résultats de l'examen histologique ont permis de faire état de 25 adénomes surrénaliens, de 15 cancers cortico‐surrénaliens, de 40 hyperplasies cortico‐surrénaliennes bilatérales et d'un seul cas