Department of Surgery, Erasmus Medical Center, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
Surg Endosc. 2012 Apr;26(4):1140-5. doi: 10.1007/s00464-011-2020-7. Epub 2011 Nov 2.
Bilateral adrenalectomy (BLA) is a treatment option to alleviate symptoms in patients with ectopic Cushing's syndrome (ECS) for whom surgical treatment of the responsible nonpituitary tumor is not possible. ECS patients have an increased risk for complications, because of high cortisol levels, poor clinical condition, and metabolic disturbances. This study aims to evaluate the safety and long-term efficacy of endoscopic BLA for ECS.
From 1990 to present, 38 patients were diagnosed and treated for ECS in the Erasmus University Medical Center, a tertiary referral center. Twenty-four patients were treated with BLA (21 endoscopic, 3 open), 9 patients were treated medically, and 5 patients could be cured by complete resection of the adrenocorticotropic hormone (ACTH)-producing tumor. The medical records were retrospectively reviewed and entered into a database. For evaluation of the efficacy of BLA, preoperative biochemical and physical symptoms were assessed and compared with postoperative data.
Endoscopic BLA was successfully completed in 20 of the 21 patients; one required conversion to open BLA. Intraoperative complications occurred in two (10%) patients, and postoperative complications occurred in three (14%) patients. Median hospitalization was 9 (2-95) days, and median operating time was 246 (205-347) min. Hypercortisolism was resolved in all patients. Improvements of hypertension, body weight, Cushingoid appearance, impaired muscle strength, and ankle edema were achieved in 87, 90, 65, 61, and 78% of the patients, respectively. Resolution of diabetes, hypokalemia, and metabolic alkalosis was achieved in 33, 89, and 80%, respectively.
Endoscopic BLA is a safe and effective treatment for patients with ectopic Cushing's syndrome.
双侧肾上腺切除术（BLA）是缓解异位库欣综合征（ECS）患者症状的一种治疗选择，对于无法手术治疗责任性垂体瘤的患者，BLA 是一种可行的治疗方法。由于皮质醇水平升高、临床状况不佳和代谢紊乱，ECS 患者有发生并发症的风险。本研究旨在评估内镜下双侧肾上腺切除术治疗 ECS 的安全性和长期疗效。
自 1990 年至今，在三级转诊中心伊拉斯谟大学医学中心，共诊断和治疗了 38 例 ECS 患者。24 例患者接受了 BLA（21 例内镜，3 例开放）治疗，9 例患者接受了药物治疗，5 例患者可通过切除促肾上腺皮质激素（ACTH）产生的肿瘤而治愈。回顾性查阅病历并录入数据库。为评估 BLA 的疗效，评估了术前生化和躯体症状，并与术后数据进行了比较。
21 例患者中的 20 例成功完成了内镜下 BLA，1 例需要转为开放 BLA。2 例（10%）患者术中发生并发症，3 例（14%）患者术后发生并发症。中位住院时间为 9（2-95）天，中位手术时间为 246（205-347）分钟。所有患者的皮质醇增多症均得到缓解。87%、90%、65%、61%和 78%的患者分别实现了高血压、体重、库欣样外观、肌肉力量受损和踝关节水肿的改善，33%、89%和 80%的患者分别实现了糖尿病、低钾血症和代谢性碱中毒的缓解。
内镜下双侧肾上腺切除术是治疗异位库欣综合征的一种安全有效的治疗方法。
