Effective reversibility of the signs and symptoms of hypercortisolism by bilateral adrenalectomy

M. A. Zeiger, D. L. Fraker, H. I. Pass, L. K. Nieman, G. B. Cutler, G. P. Chrousos, J. A. Norton

Research output: Contribution to journalArticle

Abstract

Background. The long-term outcome of bilateral adrenalectomy in the management of patients with Cushing's syndrome has not been previously well studied. Methods. We reviewed our long-term results in 34 patients treated with bilateral adrenalectomy between 1983 and the present. Fourteen presented with occult or metastatic ectopic adrenocorticotropic hormone (ACTH) syndrome, 10 with failed treatment of Cushing's disease, five with primary macronodular and four with massive macronodular adrenocortical disease and one with indeterminate cause of Cushing's syndrome. Results. All patients underwent bilateral adrenalectomy. Of 19 patients who required antihypertensive medications before operation, 15 (79%) had significant improvement and were either off all antihypertensive medication or required less medication after operation. Of 7 patients who required medications for diabetes mellitus, after operation 6 (86%) required no medication or changed from injections to oral hypoglycemic agents. Of 9 patients with mood changes or depression, the symptoms of 8 (88%) resolved. Of 29 patients with documented weight gain, 23 (79%) showed marked weight loss. Of 13 hirsute patients, 10 (77%) had resolutions of symptoms. Of 21 patients with complaints of fatigue, the symptoms of 16 (76%) resolved. Of 8 women with amenorrhea, 6 (75%) had resolution of symptoms. Each patient in the primary adrenocortical disease group, except one with residual fatigue, had complete resolution of his or her symptoms. There was no difference in resolution of symptoms between the ectopic ACTH and Cushing's disease groups. Six patients died: in the ectopic ACTH group one died of suicide at 1 month, and four of metastatic tumor at 9, 24, 25, and 48 months, and the patient with macronodular adrenocortical hyperplasia died of a myocardial infarction at 30 months. The remainder of the patients have been followed for a mean of 32 months (3 to 67 months). None of the patients had any evidence of recurrent hypercortisolism. Conclusions. We conclude that bilateral adrenalectomy is a safe, effective, and long-lasting method to ameliorate the devastating signs and symptoms of hypercortisolism in patients with Cushing's syndrome.

Original languageEnglish (US)
Pages (from-to)1138-1143
Number of pages6
JournalSurgery
Volume114
Issue number6
StatePublished - 1993
Externally publishedYes

Fingerprint

Cushing Syndrome
Adrenalectomy
Signs and Symptoms
Ectopic Hormones
Adrenocorticotropic Hormone
Pituitary ACTH Hypersecretion
Antihypertensive Agents
Fatigue
Paraneoplastic Endocrine Syndromes
Amenorrhea
Hypoglycemic Agents
Suicide
Weight Gain
Hyperplasia

ASJC Scopus subject areas

  • Surgery

Cite this

Zeiger, M. A., Fraker, D. L., Pass, H. I., Nieman, L. K., Cutler, G. B., Chrousos, G. P., & Norton, J. A. (1993). Effective reversibility of the signs and symptoms of hypercortisolism by bilateral adrenalectomy. Surgery, 114(6), 1138-1143.

Effective reversibility of the signs and symptoms of hypercortisolism by bilateral adrenalectomy. / Zeiger, M. A.; Fraker, D. L.; Pass, H. I.; Nieman, L. K.; Cutler, G. B.; Chrousos, G. P.; Norton, J. A.

In: Surgery, Vol. 114, No. 6, 1993, p. 1138-1143.

Research output: Contribution to journalArticle

Zeiger, MA, Fraker, DL, Pass, HI, Nieman, LK, Cutler, GB, Chrousos, GP & Norton, JA 1993, 'Effective reversibility of the signs and symptoms of hypercortisolism by bilateral adrenalectomy', Surgery, vol. 114, no. 6, pp. 1138-1143.
Zeiger MA, Fraker DL, Pass HI, Nieman LK, Cutler GB, Chrousos GP et al. Effective reversibility of the signs and symptoms of hypercortisolism by bilateral adrenalectomy. Surgery. 1993;114(6):1138-1143.
Zeiger, M. A. ; Fraker, D. L. ; Pass, H. I. ; Nieman, L. K. ; Cutler, G. B. ; Chrousos, G. P. ; Norton, J. A. / Effective reversibility of the signs and symptoms of hypercortisolism by bilateral adrenalectomy. In: Surgery. 1993 ; Vol. 114, No. 6. pp. 1138-1143.
@article{30b1ca82237b4a6a9956877e659d7026,
title = "Effective reversibility of the signs and symptoms of hypercortisolism by bilateral adrenalectomy",
abstract = "Background. The long-term outcome of bilateral adrenalectomy in the management of patients with Cushing's syndrome has not been previously well studied. Methods. We reviewed our long-term results in 34 patients treated with bilateral adrenalectomy between 1983 and the present. Fourteen presented with occult or metastatic ectopic adrenocorticotropic hormone (ACTH) syndrome, 10 with failed treatment of Cushing's disease, five with primary macronodular and four with massive macronodular adrenocortical disease and one with indeterminate cause of Cushing's syndrome. Results. All patients underwent bilateral adrenalectomy. Of 19 patients who required antihypertensive medications before operation, 15 (79{\%}) had significant improvement and were either off all antihypertensive medication or required less medication after operation. Of 7 patients who required medications for diabetes mellitus, after operation 6 (86{\%}) required no medication or changed from injections to oral hypoglycemic agents. Of 9 patients with mood changes or depression, the symptoms of 8 (88{\%}) resolved. Of 29 patients with documented weight gain, 23 (79{\%}) showed marked weight loss. Of 13 hirsute patients, 10 (77{\%}) had resolutions of symptoms. Of 21 patients with complaints of fatigue, the symptoms of 16 (76{\%}) resolved. Of 8 women with amenorrhea, 6 (75{\%}) had resolution of symptoms. Each patient in the primary adrenocortical disease group, except one with residual fatigue, had complete resolution of his or her symptoms. There was no difference in resolution of symptoms between the ectopic ACTH and Cushing's disease groups. Six patients died: in the ectopic ACTH group one died of suicide at 1 month, and four of metastatic tumor at 9, 24, 25, and 48 months, and the patient with macronodular adrenocortical hyperplasia died of a myocardial infarction at 30 months. The remainder of the patients have been followed for a mean of 32 months (3 to 67 months). None of the patients had any evidence of recurrent hypercortisolism. Conclusions. We conclude that bilateral adrenalectomy is a safe, effective, and long-lasting method to ameliorate the devastating signs and symptoms of hypercortisolism in patients with Cushing's syndrome.",
author = "Zeiger, {M. A.} and Fraker, {D. L.} and Pass, {H. I.} and Nieman, {L. K.} and Cutler, {G. B.} and Chrousos, {G. P.} and Norton, {J. A.}",
year = "1993",
language = "English (US)",
volume = "114",
pages = "1138--1143",
journal = "Surgery",
issn = "0039-6060",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Effective reversibility of the signs and symptoms of hypercortisolism by bilateral adrenalectomy

AU - Zeiger, M. A.

AU - Fraker, D. L.

AU - Pass, H. I.

AU - Nieman, L. K.

AU - Cutler, G. B.

AU - Chrousos, G. P.

AU - Norton, J. A.

PY - 1993

Y1 - 1993

N2 - Background. The long-term outcome of bilateral adrenalectomy in the management of patients with Cushing's syndrome has not been previously well studied. Methods. We reviewed our long-term results in 34 patients treated with bilateral adrenalectomy between 1983 and the present. Fourteen presented with occult or metastatic ectopic adrenocorticotropic hormone (ACTH) syndrome, 10 with failed treatment of Cushing's disease, five with primary macronodular and four with massive macronodular adrenocortical disease and one with indeterminate cause of Cushing's syndrome. Results. All patients underwent bilateral adrenalectomy. Of 19 patients who required antihypertensive medications before operation, 15 (79%) had significant improvement and were either off all antihypertensive medication or required less medication after operation. Of 7 patients who required medications for diabetes mellitus, after operation 6 (86%) required no medication or changed from injections to oral hypoglycemic agents. Of 9 patients with mood changes or depression, the symptoms of 8 (88%) resolved. Of 29 patients with documented weight gain, 23 (79%) showed marked weight loss. Of 13 hirsute patients, 10 (77%) had resolutions of symptoms. Of 21 patients with complaints of fatigue, the symptoms of 16 (76%) resolved. Of 8 women with amenorrhea, 6 (75%) had resolution of symptoms. Each patient in the primary adrenocortical disease group, except one with residual fatigue, had complete resolution of his or her symptoms. There was no difference in resolution of symptoms between the ectopic ACTH and Cushing's disease groups. Six patients died: in the ectopic ACTH group one died of suicide at 1 month, and four of metastatic tumor at 9, 24, 25, and 48 months, and the patient with macronodular adrenocortical hyperplasia died of a myocardial infarction at 30 months. The remainder of the patients have been followed for a mean of 32 months (3 to 67 months). None of the patients had any evidence of recurrent hypercortisolism. Conclusions. We conclude that bilateral adrenalectomy is a safe, effective, and long-lasting method to ameliorate the devastating signs and symptoms of hypercortisolism in patients with Cushing's syndrome.

AB - Background. The long-term outcome of bilateral adrenalectomy in the management of patients with Cushing's syndrome has not been previously well studied. Methods. We reviewed our long-term results in 34 patients treated with bilateral adrenalectomy between 1983 and the present. Fourteen presented with occult or metastatic ectopic adrenocorticotropic hormone (ACTH) syndrome, 10 with failed treatment of Cushing's disease, five with primary macronodular and four with massive macronodular adrenocortical disease and one with indeterminate cause of Cushing's syndrome. Results. All patients underwent bilateral adrenalectomy. Of 19 patients who required antihypertensive medications before operation, 15 (79%) had significant improvement and were either off all antihypertensive medication or required less medication after operation. Of 7 patients who required medications for diabetes mellitus, after operation 6 (86%) required no medication or changed from injections to oral hypoglycemic agents. Of 9 patients with mood changes or depression, the symptoms of 8 (88%) resolved. Of 29 patients with documented weight gain, 23 (79%) showed marked weight loss. Of 13 hirsute patients, 10 (77%) had resolutions of symptoms. Of 21 patients with complaints of fatigue, the symptoms of 16 (76%) resolved. Of 8 women with amenorrhea, 6 (75%) had resolution of symptoms. Each patient in the primary adrenocortical disease group, except one with residual fatigue, had complete resolution of his or her symptoms. There was no difference in resolution of symptoms between the ectopic ACTH and Cushing's disease groups. Six patients died: in the ectopic ACTH group one died of suicide at 1 month, and four of metastatic tumor at 9, 24, 25, and 48 months, and the patient with macronodular adrenocortical hyperplasia died of a myocardial infarction at 30 months. The remainder of the patients have been followed for a mean of 32 months (3 to 67 months). None of the patients had any evidence of recurrent hypercortisolism. Conclusions. We conclude that bilateral adrenalectomy is a safe, effective, and long-lasting method to ameliorate the devastating signs and symptoms of hypercortisolism in patients with Cushing's syndrome.

UR - http://www.scopus.com/inward/record.url?scp=0027133169&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0027133169&partnerID=8YFLogxK

M3 - Article

C2 - 8256220

AN - SCOPUS:0027133169

VL - 114

SP - 1138

EP - 1143

JO - Surgery

JF - Surgery

SN - 0039-6060

IS - 6

ER -