Efficacy analysis of unilateral adrenalectomy plus contralateral partial adrenalectomy for the treatment of 41 cases of bilateral macronodular adrenal cortical disease
10.3760/cma.j.cn112330-20250418-00162
- VernacularTitle:单侧肾上腺全切 + 对侧肾上腺大部分切除术治疗41例双侧大结节性肾上腺皮质病的疗效分析
- Author:
Xin ZHAO
1
;
Yushi ZHANG
1
;
Xuebin ZHANG
1
Author Information
1. 中国医学科学院北京协和医学院北京协和医院泌尿外科，北京 100730
- Publication Type:Journal Article
- Keywords:
Adrenal cortex diseases;
Bilateral;
Macronodular;
Adrenalectomy;
Endocrine function preservation;
Cushing’s syndrome
- From:
Chinese Journal of Urology
2025;46(7):517-522
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the efficacy of unilateral adrenalectomy combined with contralateral partial adrenalectomy in patients with bilateral macronodular adrenal cortical disease（BmacAD）.Methods:Retrospective analysis was performed on the clinical data of 41 patients with bilateral macronodular adrenal disease（BmacAD）who underwent unilateral total adrenalectomy plus contralateral partial adrenalectomy at Peking Union Medical College Hospital，Chinese Academy of Medical Sciences，between January 1990 and December 2018. The cohort comprised 27 men（65.9%）and 14 women（34.1%），with a mean age of（48.5 ± 9.3）years. The median disease duration was 60（25，108）months . Twenty-six patients（63.4%）presented with clinical features of Cushing’s syndrome（CS），while 15 patients（36.6%）did not exhibit typical CS symptoms. Endocrine evaluation revealed a median 24-hour urinary free cortisol（24h-UFC）level of 429.1（255.3，799.2）μg/24h. Plasma adrenocorticotropic hormone（ACTH）was normal in 5 patients（12.2%）and suppressed in 36 patients（87.8%）. Computed tomography（CT）imaging demonstrated typical multinodular involvement of both adrenal glands in all patients. The mean volume of the left adrenal gland was（57.4 ± 31.8）ml，the mean volume of the right adrenal gland was（48.8 ± 18.0）ml，and the mean total volume was（106.2 ± 42.1）ml. The mean maximum nodule diameter was（2.4 ± 1.0）cm. All 41 patients underwent unilateral total adrenalectomy plus contralateral partial adrenalectomy. Postoperatively，patients were followed up every 3 to 6 months to monitor symptoms and hormonal changes. Residual adrenalectomy was performed if symptoms or hormone levels did not improve or recurred.Results:Of the 41 patients，2 underwent simultaneous unilateral total adrenalectomy plus contralateral partial adrenalectomy，while 39 underwent staged procedures. The median follow-up was 56 months（range 2 to 199 months）. During the follow-up period，82.9%（34/41）of patients achieved normalization of clinical symptoms and biochemical markers postoperatively. The median time to improvement of CS symptoms was 19 months. The median 24h-UFC level at 1 week postoperatively was 385.48（219.95，525.04）μg/24h，decreasing to 56.96（37.38，88.70）μg/24h at 3 months postoperatively. All 41 patients received routine glucocorticoid supplementation postoperatively，with gradual tapering until discontinuation. The median duration of hormone replacement was 29 months（3，72）months. Among the 34 patients who did not experience recurrence，30（88.2%）were eventually able to discontinue hormone replacement，with a median duration of supplementation of 24（3，36）months，while 4（11.8%）required long-term hormone replacement. The final outcome showed that 73.2%（30/41）of patients achieved control of CS symptoms with preservation of normal adrenal function following unilateral total adrenalectomy plus contralateral partial adrenalectomy. Seven patients（17.1%）required completion adrenalectomy for residual disease. There were no statistically significant differences（ P > 0.05）in preoperative clinical symptoms，hormone levels，adrenal gland volume，or maximum nodule diameter between patients who experienced recurrence after unilateral total adrenalectomy plus contralateral partial adrenalectomy and those who did not. Conclusions:Unilateral adrenalectomy with contralateral partial adrenalectomy represents a feasible treatment strategy for BmacAD，but requires careful patient selection. This approach may offer a balance between therapeutic efficacy and preservation of adrenal function，providing a novel perspective for clinical decision-making.
