Cushing's syndrome surgery

Jump to navigation Jump to search

Cushing's syndrome Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Cushing's syndrome from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Cushing's syndrome surgery On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Cushing's syndrome surgery

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Cushing's syndrome surgery

CDC on Cushing's syndrome surgery

Cushing's syndrome surgery in the news

Blogs on Cushing's syndrome surgery

Directions to Hospitals Treating Cushing's syndrome

Risk calculators and risk factors for Cushing's syndrome surgery

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

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:
    • 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.
  3. Bilateral adrenalectomy:
    • Bilateral adrenalectomy is the usual treatment for patients with bilateral adrenal hyperplasia.
  4. 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.[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

Template:WH Template:WS