Sunday, October 6, 2013

BLA "relatively safe and provides adequate success"

I have watched several close friends get bilateral adrenalectomies in the past few months and at least another hundred get BLAs since I learned I have Cushing's in 2007. 

I am ready to have mine. With my body at its weakest but my will at its strongest, I want to get on with the rest of my life. I want to see what happens next for me.

What a timely article filled with information I need to know right at this exact moment in my life.

While it is hard to know it at the time, hindsight shows that things always work out for me.

--m

  • Journal of Clinical Endocrinology & Metabolism
  • Special Features

Outcome of Bilateral Adrenalectomy in Cushing's Syndrome: A Systematic Review

 Authors
    1. Martin Reincke
    1. Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, D-80336 München, Germany
    1. Address all correspondence and requests for reprints to: Martin Reincke, M.D., Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ziemssenstrasse 1, D-80336 München, Germany. E-mail:Martin.Reincke@med.uni-muenchen.de.
    Abstract
    Background: The outcome of bilateral adrenalectomy (BADx) in patients with Cushing's syndrome (CS) is not well characterized.
    Methods: A literature search was performed with the search terms "bilateral adrenalectomy" or "total adrenalectomy" and "Cushing's" or "Cushing." Immediate and long-term outcomes after BADx in CS were analyzed using descriptive statistics (median [range]).
    Results: From 549 screened publications, 37 studies met inclusion criteria (1320 patients, 82% having Cushing's disease [CD], 13% having ectopic CS, and 5% having primary adrenal hyperplasia). Surgical morbidity and mortality of BADx (23 studies, 739 patients) were 18% (6–31) and 3% (0–15), respectively. In patients with CD, surgical mortality was below 1%. Although residual cortisol secretion due to accessory adrenal tissue or adrenal remnants was found in 3–34% (5 studies, 236 patients), less than 2% had a relapse of CS. Symptoms of hypercortisolism (eg, hypertension, obesity, or depression) improved in the majority of the patients after BADx (7 studies, 195 patients). The number of adrenal crises per 100 patient-years was 9.3 (6 studies, 203 patients). Nelson's syndrome occurred in 21% (0–47) of the patients (24 studies, 768 patients). Mortality (23 studies, 690 patients) was 17% (0–88) at a follow-up of 41 months (14–294). Remarkably, 46% of the patients died in the first year after surgery. The median ages at death were 62 years (CD) and 53 years (ectopic CS).
    Conclusion: BADx is relatively safe and provides adequate success. Excess mortality within the first year after surgery suggests that intensive clinical care for patients after BADx is warranted.

    Footnotes

    • For editorial see page 3974

    • Abbreviations:

      BADx
      bilateral adrenalectomy
      BAH
      bilateral adrenal hypercortisolism
      CD
      Cushing's disease
      CS
      Cushing's syndrome
      ECS
      ectopic CS
      NS
      Nelson's syndrome
      QOL
      quality of life
      TSS
      transsphenoidal surgery.

    • Received February 21, 2013.
    • Accepted August 5, 2013.
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