The unpredictable outcome of autotransplanted adrenal gland tissue after bilateral surrenalectomy for Cushing's disease.

Sixty-two patients have been operated upon for Cushing's disease at our Surgical Department. Thirteen with adrenal bilateral hyperplasia underwent autotransplantation of thin slices of adrenal gland in order to overcome the inevitable disadvantages that occur after total adrenalectomy. Only in two instances was good functional activity of the transplant observed and the patients could be weaned of steroid replacement therapy. In the other patients, the transplanted tissue was an unsatisfying source of steroid hormone. In disagreement with the results of previous promising reports, adrenal autotransplantation after total adrenalectomy provided unfavorable results in the patients we studied. Eucortisolism is achieved at a low rate, increasing skin pigmentation and Nelson syndrome are not prevented. Furthermore, the transplant may hyperfunction and determine a new state of hypercortisolism. Considering our discouraging data when Cushing's syndrome has been clearly established, the use of microsurgical treatment of the pituitary gland should be favored in adult patients.