Surgical treatment of Cushing's disease caused by adrenocortical hyperplasia: experiences with bilateral adrenalectomy.

Experience with the surgical treatment of hypercorticism caused by bilateral adrenocortical hyperplasia in 16 patients is discussed. The treatment of choice is bilateral total adrenalectomy. Following subtotal adrenalectomy recurrence occurred in three of six patients; a third operation was needed in two cases, while permanent hypadrenia developed in the third. There was no operative mortality. One patient died 9 years after surgery, but the death was not related to the original disease. The clinical symptoms of hypercorticism subsided in every totally adrenalectomized patient. Indication and contraindication of adrenalectomy, the surgical method, and the problems of pre- and postoperative treatment are discussed.