High Prevalence of Adrenal Remnant Tissue in Patients Undergoing Bilateral Adrenalectomy for Cushing ’s Disease
Horm Metab Res DOI: 10.1055/a-1253-2854Bilateral adrenalectomy (BLA) is a treatment option for patients with
Cushing’s Disease (CD) if transsphenoidal pituitary surgery fails or
is not a therapeutic option. For most patients, BLA eliminates endogenous
glucocorticoid and mineralocorticoid production, but for a small number of
patients, endogenous secretion of adrenal hormones from adrenal tissue
continues or recurs, leading to signs and symptoms of hypercortisolism. If
adrenal tissue is confined to the adrenal bed, it is considered adrenal
remnant tissue, while if it is outside the adrenal bed, it is
considered adrenal rest tissue. We retrospectively evaluated morning
serum cortisol, nighttime serum cortisol, nighttime salivary cortisol, and
24-h urine free cortisol on at least three occasions in 10 patients
suspected of having endogenous cortisol production. Imaging of adrenal
remnant tissue was also reviewed. Ten of 51 patients who underwent BLA
during this time period had adrenal remnant/rest tissue marked by
detectable endogenous glucocorticoid production; 9 of the 10 patients had
signs and symptoms of hypercortisolism. Localization and treatment proved
difficult. We conclude that the incidence of adrenal remnant/rest
tissue in those undergoing BLA following unsuccessf...
Source: Hormone and Metabolic Research - Category: Endocrinology Authors: Wilson, Julian B. Zopey, Mohan Augustine, Jaimie Schaffer, Randolph Chiang, Manfred Friedman, Theodore C. Tags: Endocrine Care Source Type: research