Cushing's syndrome surgery: Difference between revisions
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==Overview== | ==Overview== | ||
If an adrenal [[adenoma]] is identified it may be removed by surgery. 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== | ==Cushing's syndrome surgery== | ||
#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. | |||
#Open adrenalectomy: | |||
#*Open adrenalectomy is recommended if adrenocortical cancer is suspected. | |||
===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> | ||
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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 surgery. 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
- 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.
- Open adrenalectomy:
- Open adrenalectomy is recommended if adrenocortical cancer is suspected.
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.[1]
References
- ↑ Nelson DH, Meakin JW, Thorn GW. ACTH-producing tumors following adrenalectomy for Cushing's syndrome. Ann Intern Med 1960;52:560–569. PMID 14426442