EFFECTIVE REVERSIBILITY OF THE SIGNS AND SYMPTOMS OF HYPERCORTISOLISMBY BILATERAL ADRENALECTOMY

Background. The long-term outcome of bilateral adrenalectomy in the ma nagement of patients with Cushing's syndrome has not been previously w ell studied. Methods. We reviewed our long-term results in 34 patients treated with bilateral adrenalectomy between 1983 and the present. Fo urteen presented with occult or metastatic ectopic adrenocorticotropic hormone (ACTH) syndrome, 10 with failed treatment of Cushing's diseas e, five with primary micronodular and four with massive macronodular a drenocortical disease and one with indeterminate cause of Cushing's sy ndrome. Results. All patients underwent bilateral adrenalectomy. Of 19 patients who required antihypertensive medications before operation, 15 (79%) had significant improvement and were either off all antihyper tensive medication or required less medication after operation. Of 7 p atients who required medications for diabetes mellitus, after operatio n 6 (86%) required no medication or changed from injections to oral hy poglycemic agents. Of 9 patients with mood changes or depression, the symptoms of 8 (88%) resolved. Of 2.9 patients with documented weight g ain, 23 (79%) showed marked weight loss. Of 13 hirsute patients, 10 (7 7%) had resolutions of symptoms. Of 21 patients with complaints of fat igue, the symptoms of 16 (76%) resolved. Of 8 women with amenorrhea, 6 (75%) had resolution of symptoms. Each patient in the primary adrenoc ortical disease group, except one with residual fatigue, had complete resolution of his or her symptoms. There was no difference in resoluti on of symptoms between the ectopic ACTH and Cushing's disease groups. Six patients die& in the ectopic ACTH group one died of suicide at 1 m onth, and four of metastatic tumor at 9, 24, 25, and 48 months, and th e patient with macronodular adrenocortical hyperplasia died of a myoca rdial infarction at 30 months. The remainder of the patients have been followed for a mean of 32 months (3 to 67 months). None of the patien ts had any evidence of recurrent hypercortisolism. Conclusions. We con clude that bilateral adrenalectomy is a safe, effective, and long-last ing method to ameliorate the devastating signs and symptoms of hyperco rtisolism in patients with Cushing's syndrome.