Cushing's syndrome is a clinical condition of excess cortisol production secondary to disorders of the pituitary, adrenal glands, or ectopic production of adrenocorticotrophic hormone (ACTH). The syndrome is manifested by obesity, hypertension, diabetes, amenorrhea, and other symptoms and with out recognition and proper treatment can result in substantial morbidity and mortality. For patients who do not respond to treatment directed at pituitary adenomas, have occult ectopic ACTH secreting tumors, or have primary bilateral adrenal disorders such as primary pigmented nodular adrenal disease or macronodular adrenal hyperplasia, bilateral adrenalectomy is effective in curing or controlling hypercortisolism and reversing the signs and symptoms of excess cortisol production (1,2). The morbidity associated with bilateral adrenalectomy is not inconsequential, and reported mortality rates range from 2% to 5% (3-6). In general, patients with Cushing's syndrome are predisposed to infectious or hemorraghic complications as well as to impaired wound healing. The open operative approache, used in our clinic for adrenalectomy is the transabdominal approach through either a midline or bilateral subcostal incision (7). The anterior approach allows a complete abdominal and retroperitoneal exploration and may be most appropriate in patients in whom a coincidental abdominal procedure is contemplated (9,10). In particular, because many of these patients are relatively young at the time of treatment and return to fully productive lives after surgery.
Scripta Scientifica Medica 2010;42(1):41-43
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