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A 30-Year,Single-Center Experience of Unilateral Adrenalectomy for Primary Bilateral Macronodular Adrenal Hyperplasia
Authors:Wenda Wang  Penghu Lian  Jianhua Deng  Hanzhong Li  Xuebin Zhang
Affiliation:Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Abstract:ObjectiveThe aim was to assess the short- and long-term outcomes of unilateral adrenalectomy (UA) in patients with primary bilateral macronodular adrenal hyperplasia (PBMAH).MethodsWe conducted a retrospective study of 124 patients with PBMAH who underwent UA.ResultsOne hundred sixteen patients were available for follow-up (median, 28.5 months). Cushingoid features remitted in 43 of 65 patients (70.8%) with overt Cushing syndrome (CS). Hypertension and diabetes mellitus improved in 79 of 96 (82.3%) and 29 of 42 patients (69.0%), respectively. Glucocorticoid insufficiency developed in 7 of 116 patients (6.0%) after the surgery, and it resolved in all the patients during follow-up. The mean 24-hour urinary free cortisol level decreased gradually from 456.02 ± 422.33 mg/24 h at baseline to 84.47 ± 70.06 mg/24 h within 3 months and then increased progressively in some patients. Sixty-four of the 116 patients (55.2%) had biochemical recurrence and 43 patients (67.2%) underwent contralateral adrenalectomy. The median time interval between the second operation and the first UA was 24 months. Patients with overt CS had a larger surgical-side or contralateral adrenal volume than patients without overt CS. Patients with a contralateral adrenal volume of >33.54 mL or with a preoperative urinary free cortisol level of >216.08 mg/24 h were more likely to have recurrence.ConclusionThe efficiency of UA is transient for the majority of patients, and the indications should be strictly limited to those with subclinical or milder CS. Patients who undergo successful UA still require close life-time follow-up for the recurrence of hypercortisolism.
Keywords:adrenocorticotropin-independent macronodular adrenal hyperplasia (AIMAH)  primary bilateral macronodular adrenal hyperplasia (PBMAH)  Cushing syndrome (CS)  unilateral adrenalectomy (UA)  follow-up  ACTH"},{"#name":"keyword","$":{"id":"kwrd0040"},"$$":[{"#name":"text","_":"adrenocorticotropic hormone  AIMAH"},{"#name":"keyword","$":{"id":"kwrd0050"},"$$":[{"#name":"text","_":"adrenocorticotropin-independent macronodular adrenal hyperplasia  CS"},{"#name":"keyword","$":{"id":"kwrd0060"},"$$":[{"#name":"text","_":"Cushing syndrome  LDDST"},{"#name":"keyword","$":{"id":"kwrd0070"},"$$":[{"#name":"text","_":"low-dose dexamethasone suppression test  PBMAH"},{"#name":"keyword","$":{"id":"kwrd0080"},"$$":[{"#name":"text","_":"primary bilateral macronodular adrenal hyperplasia  ROC"},{"#name":"keyword","$":{"id":"kwrd0090"},"$$":[{"#name":"text","_":"receiver operating characteristics  UA"},{"#name":"keyword","$":{"id":"kwrd0100"},"$$":[{"#name":"text","_":"unilateral adrenalectomy  UFC"},{"#name":"keyword","$":{"id":"kwrd0110"},"$$":[{"#name":"text","_":"urinary free cortisol
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