caa a22 4500 475801253 CHVBK 20180406123737.0 cr unu---uuuuu 170329e20000101xx s 000 0 eng 10.1007/s002689910020 doi (NATIONALLICENCE)springer-10.1007/s002689910020 Long-term Results of Total Adrenalectomy for Cushing's Disease [Elektronische Daten] [Suresh K. Nagesser, Arnoud P. van Seters, Job Kievit, Jo Hermans, H. Michiel J. Krans, Cornelis J.H. van de Velde] The objective of this study was to present the long-term results of total adrenalectomy for Cushing's disease. Forty-four patients undergoing total adrenalectomy for Cushing's disease between 1953 and 1989 at Leiden University Medical Center, The Netherlands, were studied retrospectively. Remission was achieved in 42 patients (95%), with a mean duration of 19 years. Adrenal remnants were observed in 12 patients (27%), and were without clinical consequence in the majority of patients, but caused early recurrent disease in 2 patients. Nine patients (20%) experienced Addisonian crises up to 30 years following treatment. Nelson's syndrome developed in 10 patients (23%) 7-24 years following total adrenalectomy. Prior pituitary irradiation was a protective factor against Nelson's syndrome as it delayed its onset (p= 0.025). On the other hand, subnormal dose or noncontinuous glucocorticoid replacement therapy was associated with increased risk of development of Nelson's syndrome (p= 0.047). The incidence of Nelson's syndrome increased with prolonged follow-up, and female patients seemed to be at increased risk. Quality-of-life assessment showed less favorable scores on mental health and health perception scales, for which no explanation can be found except the long-lasting metabolic effects of Cushing's disease, even when successfully treated. In conclusion, total adrenalectomy remains the final treatment for Cushing's disease. The presence of adrenal remnants which can cause recurrent disease and the development of Nelson's syndrome during prolonged follow-up enhance the need for continued regular follow-up. Pituitary irradiation prior to total adrenalectomy delays the onset of Nelson's syndrome. by the Société Internationale de Chirurgie, 2000 Nagesser Suresh K. Department of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands, NL aut van Seters Arnoud P. Department of Endocrinology and Metabolism, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands, NL aut Kievit Job Department of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands, NL aut Hermans Jo Department of Medical Statistics, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands, NL aut Krans H. Michiel J. Department of Endocrinology and Metabolism, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands, NL aut van de Velde Cornelis J.H. Department of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands, NL aut World Journal of Surgery Springer-Verlag 24/1(2000-01-01), 108-113 0364-2313 24:1<108 2000 24 268 https://doi.org/10.1007/s002689910020 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s002689910020 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Nagesser Suresh K. Department of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands, NL aut NATIONALLICENCE 700 1- van Seters Arnoud P. Department of Endocrinology and Metabolism, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands, NL aut NATIONALLICENCE 700 1- Kievit Job Department of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands, NL aut NATIONALLICENCE 700 1- Hermans Jo Department of Medical Statistics, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands, NL aut NATIONALLICENCE 700 1- Krans H. Michiel J. Department of Endocrinology and Metabolism, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands, NL aut NATIONALLICENCE 700 1- van de Velde Cornelis J.H. Department of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands, NL aut NATIONALLICENCE 773 0- World Journal of Surgery Springer-Verlag 24/1(2000-01-01), 108-113 0364-2313 24:1<108 2000 24 268 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer