Recurrent Cushing's Syndrome after Adrenal Autotransplantation

Abstract

Adrenalectomy with adrenal autotransplantation used to be performed frequently for Cushing's disease in the past because of the limitations of conventional radiological techniques and the lack of adequate neurosurgical techniques. Today, however, bilateral adrenalectomy may be still required for selective patients with Cushing's syndrome when partial hypophysectomy has failed to control hypercortisolism or the source for ectopic ACTH syndrome could not be determined. Here, we report a case of recurrent Cushing's syndrome due to a pituitary adenoma, who was treated with bilateral adrenalectomy and autotransplantation for her Cushing's syndrome. Having determined pituitary adenoma as the cause of recurrent Cushing's syndrome after endocrinological investigations and imaging, we were able to treat the patient with transsphenoidal adenomectomy. We suggest that transsphenoidal resection of the adenoma rather than excision of the autotransplants and adrenal remnants should be the preferred treatment method for recurrent Cushing's disease.

Key words

pituitary - hypercortisolism - autotransplantation - recurrent Cushing's syndrome

References

• 1 Cushing H. Surgical experiences with pitutary disorders.  JAMA. 1914;  63 1515
• 2 Makras P, Toloumis G, Papadogias D. et al . The diagnosis and differential diagnosis of endogenous Cushing's syndrome.  Hormones (Athens). 2006;  5 231-250
• 3 Pivonello R, De Martino MC, De Leo M. et al . Cushing's Syndrome.  Endocrinol Metab Clin North Am. 2008;  37 135-149 , , ix
• 4 Hardy JD, Moore DO, Langford HG. Cushing's disease today. Late follow-up of 17 adrenalectomy patients with emphasis on eight with adrenal autotransplants.  Ann Surg. 1985;  201 595-603
• 5 Hardy JD. Surgical management of Cushing's syndrome with emphasis on adrenal autotransplantation.  Ann Surg. 1978;  188 290-307
• 6 Demeter JG, De Jong SA, Brooks MH. et al . Long-term results of adrenal autotransplantation in Cushing's disease.  Surgery. 1990;  108 1117-1122 , ; discussion 1122–1113
• 7 Findling JW, Raff H. Cushing's Syndrome: important issues in diagnosis and management.  J Clin Endocrinol Metab. 2006;  91 3746-3753
• 8 Nelson DH, Meakin JW, Dealy Jr JB. et al . ACTH-producing tumor of the pituitary gland.  N Engl J Med. 1958;  259 161-164
• 9 Moore TJ, Dluhy RG, Williams GH. et al . Nelson's syndrome: frequency, prognosis, and effect of prior pituitary irradiation.  Ann Intern Med. 1976;  85 731-734
• 10 Valimaki M, Pelkonen R, Porkka L. et al . Long-term results of adrenal surgery in patients with Cushing's syndrome due to adrenocortical adenoma.  Clin Endocrinol (Oxf). 1984;  20 229-236
• 11 Ott R, Calandra D, Prinz RA. et al . Successful adrenal autotransplantation in Cushing's disease.  Surgery. 1984;  96 1054-1060
• 12 Lino B, Maurizio P, Federico R. et al . The unpredictable outcome of autotransplanted adrenal gland tissue after bilateral surrenalectomy for Cushing's disease.  Surg Gynecol Obstet. 1984;  159 461-464
• 13 Prinz RA, Brooks MH, Lawrence AM. et al . Cushing's disease: the role of adrenalectomy and autotransplantation.  Surg Clin North Am. 1979;  59 159-165
• 14 Bayer JM, Kracht J, Bethge H. et al . Cushing's syndrome recidivation caused by autotransplantation of adrenal cortex tissue after bilateral total adrenalectomy.  Acta Endocrinol Suppl (Copenh). 1971;  152 94

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