Departments of Medicine and Neurosurgery, Stanford University School of Medicine, 875 Blake Wilbur Dr MC 5826, Stanford, CA, 94305, USA,
Pituitary. 2015 Apr;18(2):269-73. doi: 10.1007/s11102-014-0633-2.
Review the indications, outcomes, and consequences of bilateral adrenalectomy (BLA) in patients with Cushing's disease.
A literature review was performed.
The primary therapy for Cushing's disease is surgery, with medical therapy and radiation therapy relegated to an adjuvant role. BLA is indicated in cases of persistent disease following pituitary surgery or in situations where rapid normalization of hypercortisolism is required. When performed via the laparoscopic approach, BLA is associated with a significantly reduced morbidity compared to the traditional, open approach. Following BLA, patients are at risk for adrenal crisis and the concern of Nelson's syndrome. However, BLA leads to a rapid resolution of the signs and symptoms of CS and leads to an improved long-term quality of life.
BLA should be considered in the treatment algorithm for patients with persistent CD after failed pituitary surgery, especially in patients who have severe consequences of hypercortisolism or desire pregnancy.
回顾库欣病患者行双侧肾上腺切除术（BLA）的适应证、结局和后果。
进行文献复习。
库欣病的主要治疗方法是手术，而药物治疗和放射治疗则作为辅助手段。BLA 适用于垂体手术后疾病仍持续存在或需要快速使皮质醇过多正常化的情况。与传统的开放方法相比，腹腔镜方法行 BLA 具有显著降低的发病率。BLA 后，患者有发生肾上腺危象和纳尔逊综合征的风险。然而，BLA 可迅速缓解 CS 的体征和症状，并提高长期生活质量。
对于垂体手术后失败的持续性库欣病患者，尤其是那些有严重皮质醇过多后果或希望妊娠的患者，应考虑将 BLA 纳入治疗方案。
