Surgical Treatment of Cushing's Syndrome in 72 Patients

During the period 1955-71, 72 patients were treated for Cushing's syndrome, caused by adrenal hy-perplasia in 58, adrenal adenoma in 9, adrenal carcinoma in 2 and pituitary tumour in 3 cases. Treatment was by hypophysectomy alone in 1 patient. Seventy-one were treated by adrenal surgery, 12 of whom had previously been subjected to pituitary irradiation. Unilateral adrenal-ectomy was done in the adrenal adenoma and carcinoma cases. In adrenal hyperplasia, attempts were made during the early years to leave part of one adrenal gland. This policy was discarded and 52 of 58 patients were subjected to total adrenalectomy. In a few early cases, a transthoracic approach was employed, but the majority were treated by either a two-stage flank approach operation or by transabdominal exposure of both adrenals simultaneously. Early postoperative mortality was 15.5% in most cases due to thromboembolic complications in poor risk patients. Two patients were hypophysectomized because of development of Nelson's syndrome. Recurrence of Cushing's syndrome occurred in 1 patient.