Unilateral adrenalectomy has been proposed in selected patients with primary bilateral macronodular adrenocortical hyperplasia (PBMAH), but its long-term outcome is unclear. Objective: The aim of this study was to analyze long-term clinical and biochemical outcomes of unilateral adrenalectomy vs bilateral adrenalectomy in patients with PBMAH in comparison with the outcome of cortisol-producing adenoma (CPA) treated with unilateral adrenalectomy. Design: Retrospective observational study in three German and one Italian academic tertiary care center. Patients and Methods: Twenty-five patients with PBMAH after unilateral adrenalectomy (unilat- ADX-PBMAH), nine patients with PBMAH and bilateral adrenalectomy (bilat-ADX-PBMAH), and 39 patients with CPA and unilateral adrenalectomy (unilat-ADX-CPA) were included. Results: Baseline clinical and biochemical parameters were comparable in patients with unilat-ADXPBMAH, bilat-ADX-PBMAH, and unilat-ADX-CPA. Directly after surgery, 84% of the patients with unilat-ADX-PBMAH experienced initial remission of Cushing syndrome (CS). In contrast, at last follow-up (median, 50 months), 32% of the patients with unilat-ADX-PBMAH were biochemically controlled compared with nearly all patients in the other two groups (P 5 0.000). Adrenalectomy of the contralateral side had to be performed in 12% of the initial patients with unilat-ADX-PBMAH. Three of 20 patients with unilat-ADX-PBMAH (15%) died during follow-up, presumably of CSrelated causes; no deaths occurred in the other two groups (P 5 0.008). Deaths occurred exclusively in patients who were not biochemically controlled after unilateral ADX.

Osswald A., Quinkler M., Di Dalmazi G., Deutschbein T., Rubinstein G., Ritzel K., et al. (2019). Long-Term Outcome of Primary Bilateral Macronodular Adrenocortical Hyperplasia after Unilateral Adrenalectomy. THE JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM, 104(7), 2985-2993 [10.1210/jc.2018-02204].

Long-Term Outcome of Primary Bilateral Macronodular Adrenocortical Hyperplasia after Unilateral Adrenalectomy

Di Dalmazi G.;
2019

Abstract

Unilateral adrenalectomy has been proposed in selected patients with primary bilateral macronodular adrenocortical hyperplasia (PBMAH), but its long-term outcome is unclear. Objective: The aim of this study was to analyze long-term clinical and biochemical outcomes of unilateral adrenalectomy vs bilateral adrenalectomy in patients with PBMAH in comparison with the outcome of cortisol-producing adenoma (CPA) treated with unilateral adrenalectomy. Design: Retrospective observational study in three German and one Italian academic tertiary care center. Patients and Methods: Twenty-five patients with PBMAH after unilateral adrenalectomy (unilat- ADX-PBMAH), nine patients with PBMAH and bilateral adrenalectomy (bilat-ADX-PBMAH), and 39 patients with CPA and unilateral adrenalectomy (unilat-ADX-CPA) were included. Results: Baseline clinical and biochemical parameters were comparable in patients with unilat-ADXPBMAH, bilat-ADX-PBMAH, and unilat-ADX-CPA. Directly after surgery, 84% of the patients with unilat-ADX-PBMAH experienced initial remission of Cushing syndrome (CS). In contrast, at last follow-up (median, 50 months), 32% of the patients with unilat-ADX-PBMAH were biochemically controlled compared with nearly all patients in the other two groups (P 5 0.000). Adrenalectomy of the contralateral side had to be performed in 12% of the initial patients with unilat-ADX-PBMAH. Three of 20 patients with unilat-ADX-PBMAH (15%) died during follow-up, presumably of CSrelated causes; no deaths occurred in the other two groups (P 5 0.008). Deaths occurred exclusively in patients who were not biochemically controlled after unilateral ADX.
2019
Osswald A., Quinkler M., Di Dalmazi G., Deutschbein T., Rubinstein G., Ritzel K., et al. (2019). Long-Term Outcome of Primary Bilateral Macronodular Adrenocortical Hyperplasia after Unilateral Adrenalectomy. THE JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM, 104(7), 2985-2993 [10.1210/jc.2018-02204].
Osswald A.; Quinkler M.; Di Dalmazi G.; Deutschbein T.; Rubinstein G.; Ritzel K.; Zopp S.; Bertherat J.; Beuschlein F.; Reincke M.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/725260
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