Login to Access Video or Poster Abstract: MP37-08
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Introduction

Partial Adrenalectomy (PA) has dramatically changed the treatment of patients affected by pathologies that affect both adrenal glands. Currently, evidences regarding the use of PA to treat primary macronodular adrenal hyperplasia(PMAH) are limited, including a small number of cases described as part of cohorts related to a variety of adrenal gland tumors. To date, the outcomes of this surgical treatment on hypercortisolism control is not known. In order to overcome the hormonal replacement caveats while minimizing the risks of hypercortisolism relapse, we performed a series of simultaneous total adrenalectomy of largest adrenal gland and contra-lateral partial adrenalectomy(adrenal sparing surgery) in patients with PMAH.

Methods

Ten patients diagnosed with PMAH were treated surgically with adrenal sparing surgery. Primary endpoint was hypercortisolism remission, considered when patients had physiologic cortisol levels (5-25 ?g/L) without hormonal reposition. Adrenal insufficiency and latent adrenal insufficiency were defined when oral hydrocortisone reposition was needed, with the dose of > 0,2 mg/kg/day and ? 0,2 mg/kg/day, respectively.Secondary endpoints were clinical and metabolic parameters improvement. Body mass index (BMI), blood pressure, cholesterol, lipid and glucose levels, were measured before and 12 months after the procedure. Medications to control comorbidities were also assessed and compared.

Results

There were no intra-operative complications and average operation time was 189 ± 34 minutes. Median hospitalization period was 7,5 days and one patient needed surgical hematoma drainage. With a median follow-up of 24 months (range: 13 to 63 months), 40% of the cohort had complete hypercortisolism remission, 20% persisted with latent adrenal insufficiency and 40% with adrenal insufficiency. Hypercortisolism recurrence was not observed. Median systolic/diastolic blood pressures were 155/95 before and 123/80 after the procedure (p < 0,001). Median number of medications to control blood hypertension diminished from 3 to 1(p < 0,001). There was no significant change in cholesterol, lipid and glucose blood levels as well as the number of diabetes and lipid lowering medications. Median BMI decreased from 31,7 ± 7,8 to 28,4 ± 4,7(p = 0.05).

Conclusions

An early assessment revealed that adrenal sparing surgery is a feasible procedure to treat patients affected by PMAH, providing hypercortisolism remission and potentially avoiding the drawbacks of lifetime corticosteroids replacement.

Funding

none