Adrenal autotransplantation with A-V anastomosis for treatment of Cushing's disease. A follow-up study of 31 cases.

Thirty-one patients with Cushing's disease were treated with bilateral adrenalectomy and partial left adrenal autotransplantation with A-V anastomosis. They were followed up for 1 to 5 years. Three patients failed after adrenal autotransplantation to the abdominal muscle with the left gland's central vein anastomosed to the inferior epigastric artery. Twenty-eight patients underwent adrenal autotransplantation to the omentum with the gland's vein anastomosed to the gastroepiploic artery. Steroid could be omitted a short period after operation and life-long replacement therapy was avoidable in most patients. A few patients subsequently developed hypocorticalism. Two died and one had recurrence of Cushing's disease. Clinical and animal experimental results showed that the omentum is suitable for adrenal autotransplantation with A-V anastomosis. Transabdominal bilateral adrenalectomy and adrenal autotransplantation to the omentum with A-V anastomosis are acceptable in the treatment of Cushing's disease. The subsequent development of hypocorticalism and recurrence of Cushing's syndrome are also discussed.