Recently, single port laparoscopic surgery has been the focus of attention due to the advanced laparoscopic skills accumulated from experience and developments in laparoscopic instruments. Herein, we present two cases of initial single port laparoscopic adrenalectomies. Case 1 was a 38-year-old female patient diagnosed with primary hyperaldosteronism because of a the right adrenal 2.5-cm sized adenoma, and case 2 was a 31-year-old female patient diagnosed with primary adrenal Cushing's syndrome because of a left adrenal 2.9-cm sized adenoma. Both patients successfully underwent single port laparoscopic adrenalectomies via a transumbilical transperitoneal approach. There was no estimated blood loss and the total operating times were 60 and 70 minutes, respectively. Both patients recovered uneventfully. We believe that this technique presented could provide potential benefits (lesser wound pain, better cosmetic satisfaction, and shorter convalescence) if the indications are carefully selected.
Adrenal Glands/surgery ; Adrenalectomy/*methods ; Adult ; Cushing Syndrome/surgery ; Female ; Humans ; Hyperaldosteronism/surgery ; Laparoscopy/*methods

BACKGROUNDCushing's disease is a pituitary-dependent type of Cushing's syndrome. Treatment consists of pituitary surgery or radiotherapy, but the recurrence rate at 10 years is as high as 40%. Adrenalectomy is considered an effective treatment to refractory Cushing's disease. The objective of this study was to examine the efficacy of laparoscopic adrenalectomy and open adrenalectomy in Cushing's disease, focusing on reversing the sequelae of hypercortisolism and improving patients' quality of life.

METHODSForty-three patients (29 women, 14 men) with recurrent Cushing's disease after transsphenoidal operation underwent laparoscopic (n = 32) or open (n = 11) adrenalectomy from 2000 to 2008. Surgical results were evaluated for all the 43 patients. Patients completed a follow-up survey, including the short-form 36-item (SF-36) health survey.

RESULTSAll the 43 patients achieved clinical reversal of hypercortisolism after adrenalectomy. Time to symptom resolution varied from a few weeks to up to 3 years. Most physical changes had resolved by a mean of 8 months after surgery. These conditions were not significantly different between the laparoscopy and open groups. Median length of hospital stay was shorter in the laparoscopy group (4 vs. 9 days; P < 0.001). Median follow-up was 48.5 months. Of the 34 (79%) patients available for follow-up, 22 (65%) had adrenocorticotropic hormone levels > 200 ng/ml and 6 (27%) had clinical Nelson syndrome. Four patients died by 75 months after surgery. Using SF-36, 30 (88%) patients reported they felt their health status was good to excellent compared with 1 year before adrenalectomy; however, they showed significantly lower scores in all the 8 SF-36 parameters compared with the general population. No significant difference emerged in SF-36 scores between the laparoscopy and open groups.

CONCLUSIONSAdrenalectomy showed high survival and clinical benefits in recurrent Cushing's disease patients. Despite patient-reported improvement in health after adrenalectomy, patients continue to experience poor health status compared with the general population.

Adolescent ; Adrenalectomy ; methods ; Adult ; Aged ; Cushing Syndrome ; surgery ; Female ; Humans ; Male ; Middle Aged ; Young Adult

Cushing's syndrome is very rare in infancy, especially in Korea. We observed a case of Cushing's syndrome in a one year and 2 month old female baby with the complaints of a 3 months history of obesty and hirsutism and 2 months history of polyphagia. There were retarded bone age, hypertension, increased urinary excretion of 17-hydroxycorticosteroid and 17-ketosteroid and eosinopenia but no thymic shadow in the chest X-ray. There was no response to the dexamethasone test (2mg divided in 4 doses orally for 2 days), which suggested an adrenal tumor. Intravenous pyelography showed that the left kidney was displaced downward as compared to the right kidney and there was a henegg sized radio-opaque shadow at the upper pole of the left kidney suggesting a left adrenal tumor. The tumor, reported as a benign adenoma pathologically, was removed successfully by anterior abdominal approach. Hypertension, eosinopenia and hypokalemia were raturned to normal from 3 days after surgery but 17-hydroxycorticosteroid and 17-ketosteroid were returned to normal from 2 weeks after surgery. We have presented this case and have reviewed the literature.
Adenoma/*pathology ; Adrenal Gland Neoplasms/*pathology ; *Adrenalectomy ; Cushing Syndrome/etiology/*surgery ; Female ; Human ; Infant

No abstract available.
Adrenalectomy ; Arginine Vasopressin/diagnostic use ; Catecholamines/physiology ; Cushing Syndrome/diagnosis/*physiopathology/surgery ; Humans ; Hydrocortisone/*secretion ; Male ; Middle Aged ; Vasopressins/physiology

Objective: To investigate the characteristics and comprehensive treatment of infected wounds in patients with iatrogenic Cushing's syndrome. Methods: A retrospective observational study was conducted. From May 2012 to December 2021, the data of 19 patients with iatrogenic Cushing's syndrome discharged from the Department of Burns and Plastic Surgery of the First Affiliated Hospital of Guangxi Medical University were collected, including 8 males and 11 females, aged 28-71 (56±11) years, with 12 cases of infected acute wounds and 7 cases of infected chronic wounds. The lesions were located in the limbs, perianal, and sacrococcygeal regions, with original infection ranging from 9 cm×5 cm to 85 cm×45 cm. After admission, the patients were performed with multidisciplinary assisted diagnosis and treatment, and the wounds were treated with debridement and vacuum sealing drainage, according to the size, severity of infection, suture tension, and bone and tendon tissue exposure of wounds, direct suture or autologous skin and/or artificial dermis and/or autologous tissue flap transplantation was selected for wound repair. The levels of cortisol and adrenocorticotropic hormone (ACTH) of patients at 8:00, 16:00, and 24:00 within 24 h after admission were counted. After admission, the number of operations, wound repair methods, and wound and skin/flap donor site healing of patients were recorded. During follow-up, the wounds were observed for recurrent infection. Results: The cortisol levels of 16 patients at 8:00, 16:00, and 24:00 within 24 h after admission were (130±54), (80±16), and (109±39) nmol/L, respectively, and ACTH levels were (7.2±2.8), (4.1±1.8), and (6.0±3.0) pg/mL, respectively; and the other 3 patients had no such statistical results. After admission, the number of surgical operation for patients was 3.4±0.9. The following methods were used for wound repair, including direct suturing in 4 cases and autologous skin and/or artificial dermis grafting in 9 cases, of which 2 cases underwent stage Ⅱ autologous skin grafting after artificial dermis grafting in stage Ⅰ, and 6 cases had pedicled retrograde island flap+autologous skin grafting. The wound healing was observed, showing that all directly sutured wounds healed well; the wounds in 6 cases of autologous skin and/or artificial dermis grafting healed well, and the wounds in 3 cases also healed well after the secondary skin grafting; the flaps in 4 cases survived well with the wounds in 2 cases with distal perforators flap arteries circumfluence obstacle of posterior leg healed after stage Ⅱ debridement and autologous skin grafting. The healing status of skin/flap donor sites was followed showing that the donor sites of medium-thickness skin grafts in the thigh of 4 cases were well healed after transplanted with autologous split-thickness grafts from scalp; the donor sites of medium-thickness skin grafts in 3 cases did not undergo split-thickness skin grafting, of which 2 cases had poor healing but healed well after secondary skin grafting 2 weeks after surgery; the donor sites of split-thickness skin grafts in the head of 2 patients healed well; and all donor sites of flaps healed well after autologous skin grafting. During follow-up of more than half a year, 3 gout patients were hospitalized again for surgical treatment due to gout stone rupture, 4 patients were hospitalized again for surgical treatment due to infection, and no recurrent infection was found in the rest of patients. Conclusions: The infected wounds in patients with iatrogenic Cushing's syndrome have poor ability to regenerate and are prone to repeated infection. Local wound treatment together with multidisciplinary comprehensive treatment should be performed to control infection and close wounds in a timely manner, so as to maximize the benefits of patients.
Adrenocorticotropic Hormone ; China ; Cushing Syndrome/surgery* ; Female ; Gout ; Humans ; Hydrocortisone ; Iatrogenic Disease ; Male ; Skin, Artificial ; Wound Infection

Cushing's syndrome in pregnant women is rare and difficult to be diagnosed because of the syndrome's association with oligomenorrhea or amenorrhea and the changes in cortisol metabolism during normal pregnancy. Cushing syndrome in pregnancy is usually confused with complicated pregnancy, such as preeclampsia or gestational diabetes, and its rarity leads to a low degree of clinical suspicion, often delaying diagnosis. We experienced a case of Cushing's syndrome in pregnancy, which had been considered as the severe preeclampsia and gestational diabetes due to uncontrolled hypertension and hyperglycemia. The pregnancy was terminated with an emergency cesarean operation at 30 weeks of gestation because of severe preeclampsia. In consequence of the evaluation about the Cushing's syndrome after delivery, the adrenal cortical adenoma of right adrenal gland was diagnosed and laparoscopic adrenalectomy was performed.
Adenoma, Adrenal Cortical/*complications/radiography/surgery ; Adrenal Cortex Neoplasms/*complications/radiography/surgery ; Adrenalectomy ; Adult ; Cushing Syndrome/*etiology/radiography/surgery ; Female ; Human ; Pregnancy ; Pregnancy Complications, Neoplastic/*radiography ; Pregnancy Outcome

No abstract available.
Adrenal Cortex Neoplasms/diagnosis/*metabolism/surgery ; Adrenalectomy ; Adrenocortical Adenoma/diagnosis/*metabolism/surgery ; Adult ; Aldosterone/*biosynthesis ; Cushing Syndrome/diagnosis ; Female ; Humans ; Hydrocortisone/*biosynthesis ; Hyperaldosteronism/metabolism

PURPOSE: A laparoscopic procedure is considered the treatment of choice for an adrenalectomy. We report our experience of a laparoscopic transperitoneal adrenalectomy in a series of 41 patients. MATERIALS AND METHODS: Between February 1999 and September 2004, 41 consecutive patients underwent a laparoscopic transperitoneal adrenalectomy. The indications for a adrenalectomy were primary aldosteronism in 16 patients, Cushing's syndrome in 7, pheochromocytoma in 6, nonfunctional adenoma in 5, adrenal cyst in 3, benign cystic teratoma in 2, myelolipoma in 1 and metastatic renal cell carcinoma in 1. The author analyzed the results of each operation. RESULTS: The affected adrenal gland was successfully removed, with the exception of 3 cases. Conversion to open surgery was necessary in 3 of the pheochromocytoma patients due to massive intraoperative bleeding and severe adhesion to retroperitoneal fat. The mean operative time was 245.3 minutes (125-420). The mean intraoperative blood loss and adrenal mass size were 189.6ml (20-2100) and 3.6cm (1.0-10.4), respectively. The mean post-operative hospital stay was 10.4 days (5-29). The mean times to oral intake and ambulation were 1.4 (1-3) and 1.0 days (1-2) after the operation, respectively. The mean number of days of analgesic administration was 2.1 (0-6). The conversion and major complication rates were 7.3 and 10.5%, respectively. CONCLUSIONS: A laparoscopic adrenalectomy is safe and effective in nearly all adrenal pathologies, with early oral intake, ambulation and a low number of days of pain control.
Adenoma ; Adrenal Glands ; Adrenalectomy* ; Carcinoma, Renal Cell ; Conversion to Open Surgery ; Cushing Syndrome ; Hemorrhage ; Humans ; Hyperaldosteronism ; Intra-Abdominal Fat ; Laparoscopy ; Length of Stay ; Myelolipoma ; Operative Time ; Pathology ; Pheochromocytoma ; Teratoma ; Walking

PURPOSE: Single port laparoscopic surgery is an area of active investigation in abdominal surgery. A standard procedure for single port laparoscopic adrenal surgery has not been established. We retrospectively investigated intraoperative and postoperative outcomes following laparoscopic adrenalectomy via mono-port (LAMP). METHODS: Between March 2009 and December 2009, 10 patients underwent LAMP at Kangbuk Samsung Hospital. The same surgeon performed all surgeries. The first 5 cases underwent LAMP using an Alexis Wound Retractor (Applied Medical, Rancho Santa Margarita, CA, USA) with surgical gloves, and others were done with an OCTO Port (Dalim Surgnet, Korea). RESULTS: Of the 10 patients, 5 were male and 5 were female. The mean age was 43.7±9.9 years (range, 34~62), and the mean BMI was 24.1±4.0 kg/m² (Range, 17.1 ~30.0). The mean tumor size was 32.5±16.9 mm (range, 12~60),mean operative time was 127.0±29.5 min (range, 90~180), and mean hospital stay was 4.5 days (range, 3~7). Three patients were diagnosed with non-functioning cortical adenoma, 3 with Cushing's syndrome, 2 patients with pheochromocytoma, and others with primarily hyperaldosteronism and myelolipoma. Major postoperative morbidity, blood transfusions, or conversion to open surgery did not occur. CONCLUSION: The outcome of LAMP demonstrates the safety and feasibility of this procedure. With increasing surgeon experience and refinement in instrument technology, we believe LAMP is likely to become a standard approach to adrenal disease.
Adenoma ; Adrenalectomy* ; Blood Transfusion ; Conversion to Open Surgery ; Cushing Syndrome ; Female ; Gloves, Surgical ; Humans ; Hyperaldosteronism ; Laparoscopy ; Length of Stay ; Male ; Myelolipoma ; Operative Time ; Pheochromocytoma ; Retrospective Studies ; Wounds and Injuries

Objective: To explore the value of catheter-based adrenal ablation in treating Cushing's syndrome (CS)-associated hypertension. Methods: A clinical study was conducted in patients with CS, who received catheter-based adrenal ablation between March 2018 and July 2023 in Daping Hospital. Parameters monitored were blood pressure (outpatient and 24-hour ambulatory), body weight, clinical characteristics, serum cortisol and adrenocorticotropic hormone (ACTH) at 8 am, 24-hour urinary free cortisol (24 h UFC), fasting blood glucose and postoperative complications. Procedure effectiveness was defined as blood pressure returning to normal levels (systolic blood pressure<140 mmHg (1 mmHg=0.133 kPa) and diastolic blood pressure<90 mmHg), cortisol and 24 h UFC returning to normal and improvement of clinical characteristics. The parameters were monitored during follow up in the outpatient department at 1, 3, 6, and 12 months after catheter-based adrenal ablation. Results: A total of 12 patients (aged (40.0±13.2) years) were reviewed. There were 5 males, with 5 cases of adenoma and 7 with hyperplasia from imaging studies. Catheter-based adrenal ablation was successful in all without interruption or surgical conversion. No postoperative complication including bleeding, puncture site infection, adrenal artery rupture or adrenal bleeding was observed. The mean follow up was 28 months. Compared to baseline values, body weight declined to (59.48±11.65) kg from (64.81±10.75) kg (P=0.008), fasting blood glucose declined to (4.54±0.83) mmol from (5.53±0.99) mmol (P=0.044), outpatient systolic blood pressure declined to (128±21) mmHg from (140±19) mmHg (P=0.005), diastolic blood pressure declined to (78±10) mmHg from (86±11) mmHg (P=0.041), and the mean ambulatory daytime diastolic blood pressure declined to (79±12) mmHg from (89±8) mmHg (P=0.034). Catheter-based adrenal ablation in 8 patients was defined as effective with their 24 h UFC significantly reduced after the procedure (1 338.41±448.06) mmol/L from (633.66±315.94) mmol/L, P=0.011). The change of 24 h UFC between the effective treatment group and ineffective group was statistically significant (P=0.020). The postoperative systolic blood pressure in the treated adenoma group was significantly lower than those of hyperplasia group (112±13) mmHg vs. (139±20) mmHg, P=0.026). Conclusions: For patients with CS-associated hypertension who are unwilling or unable to undergo surgical treatment, catheter-based adrenal ablation could improve the blood pressure and cortisol level. Catheter-based adrenal ablation could be a safe, effective, and minimally invasive therapy. However, our results still need to be validated in further large-scale studies.
Male ; Humans ; Cushing Syndrome/complications* ; Hydrocortisone ; Adrenal Gland Neoplasms/surgery* ; Feasibility Studies ; Blood Glucose ; Hyperplasia/complications* ; Hypertension/complications* ; Adenoma/complications* ; Body Weight ; Catheters/adverse effects*