Long-Term Outcome of Bilateral Laparoscopic Adrenalectomy Measured by Disease-Specific Questionnaire in a Unique Group of Patients with Cushing's Syndrome

Abstract

Background: Laparoscopic bilateral adrenalectomy (LBA) is recommended for patients with bilateral adrenal disease and occult or unresectable ectopic Cushing's syndrome (CS). There are limited data on long-term outcomes after LBA, partly due to the lack of disease-specific tools for the measurement of impact on patients' health and quality of life.

Methods: We used a disease-specific questionnaire covering all major clinicopathologic characteristics of CS. We compared the outcome from LBA to a control group of 60 patients who had thyroidectomy (matched for age, gender, and time of surgery, 2:1 control-to-CS).

Results: Twenty-eight patients (20 women and 8 men) underwent LBA for CS. Of them, 24 patients (86 %) provided responses to our questionnaire. Ninety-two percent of patients' responses indicated a significant improvement of general Cushing's physical features with complete resolution reported in 59 % of responses. Significant improvement of associated biochemical abnormalities and comorbidities was reported in 83 % of patients' responses including complete reversal in 58 %. Significant improvement in emotional-behavioral symptoms was reported in 84 % of patients' responses with complete recovery in 53 %. All patients expressed satisfaction with LBA and significant improvement in their general health and self-reported quality of life. All of the improvements after LBA were statistically significant compared with the control group.

Conclusions: Our disease-specific questionnaire enables a clearer understanding of the association between the clinical, metabolic, and emotional-behavioral features of CS, its treatment with LBA, and long-term impact on patient-reported quality of life. This disease-specific questionnaire may be useful for future studies in patients with CS.

Trial registration: ClinicalTrials.gov NCT00005927 NCT01005654 NCT02001051.

Conflict of interest statement

CONFLICT OF INTEREST Authors have no conflict of interest to declare.

Figures

FIG. 1

Schematic of study design. 1 CS—Cushing’s syndrome, 2 LBA—Laparoscopic bilateral adrenalectomy, 3 Control group patients matched for age, gender, time of surgery (thyroidectomy), and needed postoperative hormone replacement therapy

FIG. 2

Long-term effect of LBA on symptoms and signs of CS. Percentage of responses calculated based on responses of patients who had symptoms preoperatively, CS Cushing’s syndrome, LBA laparoscopic bilateral adrenalectomy, GCP General Cushing’s physical features, BAC biochemical abnormalities/comorbidities, EB Emotional-Behavioral Features

FIG. 3

Comparison of scores of patients with CS versus control group. Blue bars—Cushing’s syndrome cohort; Yellow bars—control group, GCP General Cushing’s physical features; a tendency to gain weight unevenly (p < 0.0001); b weakness and wasting of proximal muscle groups (p = 0.0008); c had thinning and easy bruising of the skin with pink or purple striae (p < 0.0001); d worsening acne, facial hair growth/scalp hair loss (in women) and skin darkening (p = 0.0002); BAC Biochemical Abnormalities/Comorbidities; a hypertension (HTN) preoperatively (p < 0.0001); b menstrual cycle irregularity (p < 0.0001); c secondary hyperglycemia (p < 0.0001); d history of recurrent low-trauma fractures (p < 0.0001); EB Emotional-Behavioral Features; a generalized fatigue and malaise (p < 0.0001); b anxiety (p = 0.0008); c depression (p = 0.007); d mood swing; level of symptoms (p < 0.0001)