ROLE OF PREOPERATIVE IODOCHOLESTEROL SCINTISCANNING IN PATIENTS UNDERGOING ADRENALECTOMY FOR CUSHINGS-SYNDROME

Background. Iodocholesterol scintiscanning (IS) is a noninvasive, func tional diagnostic test. We report our experience with IS as an adjunct for adrenal surgery for Cushing's syndrome. Methods. Between April 19 83 and October 1994, 23 patients with Cushing's syndrome from benign p rimary adrenal disease underwent IS and computed tomography (CT) and/o r magnetic resonance imaging (MRI). Twelve patients had unilateral adr enal involvement with a solitary adenoma (n = 11) or unilateral multin odular disease (n = 1), and 11 patients had bilateral adrenal disease. Results. In patients with Cushing's syndrome caused by unilateral adr enal disease, IS was 100% specific and 100% sensitive, whereas in two cases CT/MRI incorrectly showed bilateral disease. In patients with Cu shing's syndrome with bilateral adrenal involvement, IS had one false- negative result with nonvisualization. CT/MRI showed unilateral diseas e in four cases and no abnormalities in two. All patients in this seri es were cured of Cushing's syndrome after unilateral adrenalectomy in 11 cases and bilateral adrenalectomy in 12 cases. Conclusions. IS is a highly sensitive and specific imaging modality and is an essential ad junct to biochemical testing in planning adrenal resections for Cushin g's syndrome caused by primary adrenal disease.