Surgical experience with Cushing's disease.

During the period 1952 to 1976 at Vanderbilt University Hospital 119 patients with pituitary-dependent hypercortisolism or Cushing's disease were studied. The less severe cases, which constitute a majority, were treated by pituitary irradiation with endocrinologic cure or improvement in two-thirds of the treated patients. Bilateral total adrenalectomy was reserved for the most severe cases and for failures of pituitary irradiation. In 29 patients with total bilateral adrenalectomy there was one postoperative death. Two of 28 survivors had incomplete relief of hypercortisolism and required additional therapy for its control. One patient with recent operation is improved and another with early improvement died suddenly at home three months after operation. The 24 other adrenalectomized patients, followed 6 months to 20 years, were considered endocrinologic cures of Cushing's disease. One patient in the group who had not received pituitary irradiation developed signs of expanding pituitary tumor after adrenalectomy (Nelson's syndrome) with satisfactory response to radiation therapy.