Indian journal of endocrinology and metabolism · 2019
Outcomes of Bilateral Adrenalectomy in Cushing's Syndrome.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Nagendra Lakshmi, Bhavani Nisha, Pavithran Praveen V, Kumar Ginil P, Menon Usha V, Menon Arun S, Kumar Lakshmi, Kumar Harish, Nair Vasantha, Abraham Nithya, Narayanan Prem
Аннотация
CONTEXT: The literature on outcomes of bilateral adrenalectomy (BADx) in Cushing's syndrome (CS) is scant.
AIMS: The aim of this study is to analyze the short- and long-term outcomes of patients who underwent BADx and to compare the outcomes among different etiologies of CS.
SETTINGS AND DESIGN: This is a retrospective analysis of patients who underwent BADx for CS at our center between 2005 and 2018.
MATERIALS AND METHODS: In all, 33 patients were studied for clinical outcomes, survival rates, and long-term complications.
STATISTICAL ANALYSIS: All analyses were performed with SPSS software (version 21.0).
RESULTS: The mean age at surgery was 39.33 ± 15.67 years. The primary etiology for CS was Cushing's disease (CD) in 42.42%, ectopic source in 36.36%, primary pigmented nodular adrenocortical disease (PPNAD) in 12.12%, and adrenocorticotrophin hormone-independent macronodular adrenal hyperplasia (AIMAH) in 9.09% of patients. The median follow-up time was 72.77 months. Improvement in hypertension and diabetes status after surgery was seen in 78% and 76.19% of patients, respectively. Proximal myopathy improved in 68% of patients. Nelson's syndrome and adrenal crisis were seen in 21.4% of patients each on long-term follow-up. Total mortality after BADx was 33.3%. Mortality in the first 30 days after surgery was seen in five patients (15.15%). Higher cortisol levels at presentation and age more than 40 years were predictors of mortality. Among the Cushing's subtypes, PPNAD had the best prognosis followed by CD. Perioperative Infections were a major cause of mortality.
CONCLUSION: BADx is an effective treatment for CS especially in patients with PPNAD and CD but carries a significant mortality rate too.
AIMS: The aim of this study is to analyze the short- and long-term outcomes of patients who underwent BADx and to compare the outcomes among different etiologies of CS.
SETTINGS AND DESIGN: This is a retrospective analysis of patients who underwent BADx for CS at our center between 2005 and 2018.
MATERIALS AND METHODS: In all, 33 patients were studied for clinical outcomes, survival rates, and long-term complications.
STATISTICAL ANALYSIS: All analyses were performed with SPSS software (version 21.0).
RESULTS: The mean age at surgery was 39.33 ± 15.67 years. The primary etiology for CS was Cushing's disease (CD) in 42.42%, ectopic source in 36.36%, primary pigmented nodular adrenocortical disease (PPNAD) in 12.12%, and adrenocorticotrophin hormone-independent macronodular adrenal hyperplasia (AIMAH) in 9.09% of patients. The median follow-up time was 72.77 months. Improvement in hypertension and diabetes status after surgery was seen in 78% and 76.19% of patients, respectively. Proximal myopathy improved in 68% of patients. Nelson's syndrome and adrenal crisis were seen in 21.4% of patients each on long-term follow-up. Total mortality after BADx was 33.3%. Mortality in the first 30 days after surgery was seen in five patients (15.15%). Higher cortisol levels at presentation and age more than 40 years were predictors of mortality. Among the Cushing's subtypes, PPNAD had the best prognosis followed by CD. Perioperative Infections were a major cause of mortality.
CONCLUSION: BADx is an effective treatment for CS especially in patients with PPNAD and CD but carries a significant mortality rate too.