Cushing's syndrome surgery: Difference between revisions
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==Overview== | ==Overview== | ||
If an adrenal [[adenoma]] is identified it may be removed by | If an adrenal [[adenoma]] is identified it may be removed by either [[laparoscopic]] or open [[adrenalectomy]]. An [[ACTH-secreting tumor|ACTH-secreting]] [[corticotrophic]] [[pituitary adenoma]] should be removed after diagnosis. Regardless of the [[Adenoma|adenoma's]] location, most patients will require [[steroid]] replacement postoperatively at least in the interim as long-term suppression of [[ACTH|pituitary ACTH]] and normal adrenal tissue does not recover immediately. Clearly, if both [[Adrenal gland|adrenals]] are removed, replacement with [[hydrocortisone]] or [[prednisolone]] is imperative. | ||
==Cushing's syndrome surgery== | ==Cushing's syndrome surgery== | ||
The following surgical methods are usually used to treat Cushing's disease.<ref name="pmid26004339">{{cite journal |vauthors=Lacroix A, Feelders RA, Stratakis CA, Nieman LK |title=Cushing's syndrome |journal=Lancet |volume=386 |issue=9996 |pages=913–27 |year=2015 |pmid=26004339 |doi=10.1016/S0140-6736(14)61375-1 |url=}}</ref> | The following surgical methods are usually used to treat Cushing's disease.<ref name="pmid26004339">{{cite journal |vauthors=Lacroix A, Feelders RA, Stratakis CA, Nieman LK |title=Cushing's syndrome |journal=Lancet |volume=386 |issue=9996 |pages=913–27 |year=2015 |pmid=26004339 |doi=10.1016/S0140-6736(14)61375-1 |url=}}</ref> | ||
#'''Transsphenoidal pituitary resection:''' | #'''Transsphenoidal [[pituitary]] [[resection]]:''' | ||
#*Transsphenoidal selective tumor resection (TSS) is the initial treatment of Cushing’s disease arising from pituitary adenoma. | #*Transsphenoidal selective tumor resection (TSS) is the initial treatment of Cushing’s disease arising from [[pituitary adenoma]]. | ||
#'''Laparoscopic adrenalectomy:''' | #'''[[Laparoscopic]] [[adrenalectomy]]:''' | ||
#*Minimally invasive unilateral [[adrenalectomy]] is the standard of care for cortisol-secreting unilateral adenomas. These procedures are safe, effective, and comparatively less than open adrenalectomy. | #*Minimally invasive unilateral [[adrenalectomy]] is the standard of care for [[Cortisol-secreting tumor|cortisol-secreting unilateral adenomas]]. These procedures are safe, effective, and comparatively less than open [[adrenalectomy]]. | ||
#'''Bilateral adrenalectomy:''' | #'''[[Bilateral]] [[adrenalectomy]]:''' | ||
#*Bilateral [[adrenalectomy]] is the usual treatment for patients with bilateral adrenal hyperplasia. | #*[[Bilateral]] [[adrenalectomy]] is the usual treatment for patients with [[Bilateral adrenal hyperplasia|bilateral adrenal hyperplasia.]] | ||
#'''Open adrenalectomy:''' | #'''Open [[adrenalectomy]]:''' | ||
#*Open [[adrenalectomy]] is recommended if adrenocortical cancer is suspected. | #*Open [[adrenalectomy]] is recommended if [[Adrenocortical carcinoma|adrenocortical cancer]] is suspected. | ||
Regardless of the adenoma's location, most patients will require steroid replacement postoperatively at least in the interim as long-term suppression of pituitary ACTH and normal adrenal tissue does not recover immediately. Clearly, if both adrenals are removed, replacement with hydrocortisone or prednisolone is imperative. | Regardless of the [[Adenoma|adenoma's]] location, most patients will require [[steroid]] replacement postoperatively at least in the interim as long-term suppression of [[ACTH|pituitary ACTH]] and normal [[adrenal]] tissue does not recover immediately. Clearly, if both [[Adrenal gland|adrenals]] are removed, replacement with [[hydrocortisone]] or [[prednisolone]] is imperative. | ||
===Nelson's syndrome=== | ===Nelson's syndrome=== | ||
Removal of the adrenals in the absence of a known tumor is occasionally performed to eliminate the production of excess cortisol. In some occasions, this removes negative feedback from a previously occult pituitary adenoma, which starts growing rapidly and produces extreme levels of ACTH, leading to [[hyperpigmentation]]. This clinical situation is known as [[Nelson's syndrome]].<ref>Nelson DH, Meakin JW, Thorn GW. ''ACTH-producing tumors following adrenalectomy for Cushing's syndrome.'' Ann Intern Med 1960;52:560–569. PMID 14426442</ref> | Removal of the adrenals in the absence of a known tumor is occasionally performed to eliminate the production of excess [[cortisol]]. In some occasions, this removes negative feedback from a previously occult [[pituitary adenoma]], which starts growing rapidly and produces extreme levels of [[ACTH]], leading to [[hyperpigmentation]]. This clinical situation is known as [[Nelson's syndrome]].<ref>Nelson DH, Meakin JW, Thorn GW. ''ACTH-producing tumors following adrenalectomy for Cushing's syndrome.'' Ann Intern Med 1960;52:560–569. PMID 14426442</ref> | ||
==References== | ==References== | ||
Latest revision as of 20:04, 23 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2]
Overview
If an adrenal adenoma is identified it may be removed by either laparoscopic or open adrenalectomy. An ACTH-secreting corticotrophic pituitary adenoma should be removed after diagnosis. Regardless of the adenoma's location, most patients will require steroid replacement postoperatively at least in the interim as long-term suppression of pituitary ACTH and normal adrenal tissue does not recover immediately. Clearly, if both adrenals are removed, replacement with hydrocortisone or prednisolone is imperative.
Cushing's syndrome surgery
The following surgical methods are usually used to treat Cushing's disease.[1]
- Transsphenoidal pituitary resection:
- Transsphenoidal selective tumor resection (TSS) is the initial treatment of Cushing’s disease arising from pituitary adenoma.
- Laparoscopic adrenalectomy:
- Minimally invasive unilateral adrenalectomy is the standard of care for cortisol-secreting unilateral adenomas. These procedures are safe, effective, and comparatively less than open adrenalectomy.
- Bilateral adrenalectomy:
- Bilateral adrenalectomy is the usual treatment for patients with bilateral adrenal hyperplasia.
- Open adrenalectomy:
- Open adrenalectomy is recommended if adrenocortical cancer is suspected.
Regardless of the adenoma's location, most patients will require steroid replacement postoperatively at least in the interim as long-term suppression of pituitary ACTH and normal adrenal tissue does not recover immediately. Clearly, if both adrenals are removed, replacement with hydrocortisone or prednisolone is imperative.
Nelson's syndrome
Removal of the adrenals in the absence of a known tumor is occasionally performed to eliminate the production of excess cortisol. In some occasions, this removes negative feedback from a previously occult pituitary adenoma, which starts growing rapidly and produces extreme levels of ACTH, leading to hyperpigmentation. This clinical situation is known as Nelson's syndrome.[2]
References
- ↑ Lacroix A, Feelders RA, Stratakis CA, Nieman LK (2015). "Cushing's syndrome". Lancet. 386 (9996): 913–27. doi:10.1016/S0140-6736(14)61375-1. PMID 26004339.
- ↑ Nelson DH, Meakin JW, Thorn GW. ACTH-producing tumors following adrenalectomy for Cushing's syndrome. Ann Intern Med 1960;52:560–569. PMID 14426442