| The role of unilateral adrenalectomy in ACTH-independent macronodular adrenal hyperplasia (AIMAH). | |
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MedLine Citation:
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PMID: 18214589 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: ACTH-independent macronodular adrenal hyperplasia (AIMAH) is a rare cause of Cushing's syndrome. Bilateral adrenalectomy is considered the treatment of choice, with subsequent lifetime steroid replacement, but unilateral adrenalectomy has been recently proposed to reduce the secreting tissue. This prospective study was designed to evaluate the long-term results of unilateral adrenalectomy in AIMAH concerning the main laboratory and clinical abnormalities and the patient's quality of life. METHODS: Seven consecutive patients with confirmed AIMAH underwent unilateral adrenalectomy of the largest gland. ACTH and cortisol levels, arterial blood pressure (BP), glycometabolic parameters, and patient's subjective perception of health-related quality of life (by the SF-36 questionnaire) were measured preoperatively and postoperatively. RESULTS: No surgery-related morbidity occurred. One patient with a large contralateral adrenal enlargement required a completion adrenalectomy after 7 months because of persistent hypercortisolism. At a median follow-up of 53 (range, 27-68) months, the remaining six patients were cured, because serum and urinary free cortisol levels significantly decreased and ACTH increased, thus regaining the normal range. Both systolic and diastolic BP levels significantly reduced: 50% of patients definitively became normotensive, and the remaining patients reduced the need for antihypertensive treatment; 40% of patients suffering from preoperative diabetes were cured, whereas 40% reduced the need for hypoglycemizing drug. SF-36 evaluation of the health-related quality of life confirmed a significant amelioration. CONCLUSIONS: Unilateral adrenalectomy of the largest gland can be an effective and safe treatment for AIMAH in case of asymmetric involvement. It may achieve long-term remission of Cushing's syndrome and improve BP values, glycemic control, and patient's quality of life. |
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Authors:
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Maurizio Iacobone; Nora Albiger; Carla Scaroni; Franco Mantero; Ambrogio Fassina; Giovanni Viel; Mauro Frego; Gennaro Favia |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: World journal of surgery Volume: 32 ISSN: 0364-2313 ISO Abbreviation: World J Surg Publication Date: 2008 May |
Date Detail:
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Created Date: 2008-04-18 Completed Date: 2008-10-10 Revised Date: 2009-04-16 |
Medline Journal Info:
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Nlm Unique ID: 7704052 Medline TA: World J Surg Country: United States |
Other Details:
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Languages: eng Pagination: 882-9 Citation Subset: IM |
Affiliation:
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Endocrine Surgery Unit, Department of Surgical and Gastroenterological Sciences, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy. maurizio.iacobone@unipd.it |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adrenal Glands
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pathology* Adrenalectomy* Adrenocorticotropic Hormone / blood* Adult Aged Female Follow-Up Studies Humans Hydrocortisone / blood Hyperplasia / blood, diagnosis, surgery Male Middle Aged Prospective Studies Quality of Life* Time Factors Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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50-23-7/Hydrocortisone; 9002-60-2/Adrenocorticotropic Hormone |
| Comments/Corrections | |
Comment In:
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World J Surg. 2009 Jan;33(1):157-8; author reply 159
[PMID:
18825451
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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