Wang W, Lian P, Deng J, Li H, Zhang X. A 30-year single-center experience of unilateral adrenalectomy for primary bilateral macronodular adrenal hyperplasia.
Endocr Pract 2022;
28:690-695. [PMID:
35487460 DOI:
10.1016/j.eprac.2022.04.011]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE
The aim of this study is to assess the short- and long-term outcomes of unilateral adrenalectomy (UA) in patients with primary bilateral macronodular adrenal hyperplasia (PBMAH).
METHODS
We conducted a retrospective study of 124 patients with PBMAH who underwent UA.
RESULTS
124 adrenalectomies were performed without intraoperative mortality. After a median duration of 28.5months (1∼165months, mean 51.92 ± 47.21 months), 116 patients were available for follow-up. Cushingoid features remitted in 70.8% (43/65) of patients with overt Cushing's Syndrome (CS). Hypertension and diabetes mellitus improved in 82.3% (79/96) and 69.0% (29/42) of patients respectively. 6.0% (7/116) of patients developed glucocorticoid insufficiency postoperatively, and all resolved during the follow-up. The mean 24h-UFC (reference range 12.3∼103.5μg/24h) decreased gradually from 456.02±422.33μg/24hr at baseline to 84.47±70.06μg/24hr within 3 months and then climbed progressively in some patients. 55.2% (64/116) had biochemical recurrence with/without symptom recurrence and 67.2% (43/64) of them received contralateral adrenalectomy. The median interval time of the second operation from the first UA was 24 months (1∼165months, mean 43.58 ± 44.54 months), and it took less time in patients with overt CS (median 22 months, 1∼165 months, mean 37.24 ± 41.85 months) than those without overt CS (median 72 months, 1∼144 months, mean 61.45 ± 46.73 months). Patients with overt CS had larger surgical-side or contralateral adrenal volume than that of patients without overt CS. Patients with contralateral adrenal volume larger than 33.54ml or with pre-operative UFC more than 216.08μg/24hr were more likely to have recurrence.
CONCLUSION
The efficiency of UA is transient for majority of patients, and the indications should be strictly limited to those with subclinical or milder CS. The successful UA patients still require close lifetime follow-up for recurrence of hypercortisolism.
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