Laparoscopic adrenalectomy for adrenocorticotropin-dependent Cushing's syndrome

Bilateral adrenalectomy is indicated for the treatment of ACTH-dependent Gu shing's syndrome when the tumorous source of ACTH hypersecretion cannot be identified or removed. Potential advantages of laparoscopic over open adren alectomy include shorter hospitalization, decreased requirement for postope rative analgesia, and decreased postoperative morbidity due to incisional c omplications. Bilateral laparoscopic adrenalectomy performed for the treatment of ACTH-de pendent Gushing's syndrome was attempted in 19 patients at our institution between 1995 and 1998. Conversion to an open procedure was required in thre e patients. All patients who underwent bilateral laparoscopic adrenalectomy were subsequently followed to assess the outcome of this intervention. Twelve patients with pituitary-dependent Gushing's syndrome and four with e ctopic ACTH syndrome underwent successful bilateral laparoscopic adrenalect omy. All patients experienced resolution of the signs and symptoms (e.g. pr oximal myopathy, hirsutism, and emotional lability) of Gushing's syndrome a s well as weight loss, improved glucose tolerance, and improved control of blood pressure. No residual cortisol secretion was detected in the patients . Bilateral laparoscopic adrenalectomy is a safe and effective treatment for Gushing's syndrome when the ACTH-secreting neoplasm cannot be removed.