Document Detail


The role of unilateral adrenalectomy in ACTH-independent macronodular adrenal hyperplasia (AIMAH).
MedLine Citation:
PMID:  18214589     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Maurizio Iacobone; Nora Albiger; Carla Scaroni; Franco Mantero; Ambrogio Fassina; Giovanni Viel; Mauro Frego; Gennaro Favia
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  World journal of surgery     Volume:  32     ISSN:  0364-2313     ISO Abbreviation:  World J Surg     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-04-18     Completed Date:  2008-10-10     Revised Date:  2009-04-16    
Medline Journal Info:
Nlm Unique ID:  7704052     Medline TA:  World J Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  882-9     Citation Subset:  IM    
Affiliation:
Endocrine Surgery Unit, Department of Surgical and Gastroenterological Sciences, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy. maurizio.iacobone@unipd.it
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MeSH Terms
Descriptor/Qualifier:
Adrenal Glands / 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:
50-23-7/Hydrocortisone; 9002-60-2/Adrenocorticotropic Hormone
Comments/Corrections
Comment In:
World J Surg. 2009 Jan;33(1):157-8; author reply 159   [PMID:  18825451 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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