Cushing's syndrome surgery: Difference between revisions

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==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]]:'''

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]

  1. Transsphenoidal pituitary resection:
    • Transsphenoidal selective tumor resection (TSS) is the initial treatment of Cushing’s disease arising from pituitary adenoma.
  2. Laparoscopic adrenalectomy:
  3. Bilateral adrenalectomy:
  4. Open adrenalectomy:

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

  1. 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.
  2. Nelson DH, Meakin JW, Thorn GW. ACTH-producing tumors following adrenalectomy for Cushing's syndrome. Ann Intern Med 1960;52:560–569. PMID 14426442

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