A New Insight into the Surgical Treatment of Primary Macronodular Adrenal Hyperplasia

Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSPTANNO, Fabio YoshiakiSROUGI, VictorALMEIDA, Madson Q.YAMAUCHI, Fernando IdeCOELHO, Fernando Morbeck AlmeidaNISHI, Mirian YumieZERBINI, Maria Claudia NogueiraSOARES, Iracy Silvia CorreaPEREIRA, Maria Adelaide AlbergariaCHARCHAR, Helaine Laiz SilvaLACOMBE, Amanda Meneses FerreiraBRONDANI, Vania BalderramaSROUGI, MiguelNAHAS, Willian CarlosMENDONCA, Berenice B.CHAMBO, Jose LuisFRAGOSO, Maria Candida Barisson Villares2020-10-152020-10-152020JOURNAL OF THE ENDOCRINE SOCIETY, v.4, n.8, article ID bvaa083, 14p, 2020https://observatorio.fm.usp.br/handle/OPI/37888Purpose: This prospective study presents the results of a new approach in the treatment of primary macronodular adrenal hyperplasia (PMAII), with simultaneous total adrenalectomy of the larger adrenal gland and partial adrenalectomy of the contralateral adrenal gland (adrenal-sparing surgery). Materials and Methods: We performed a prospective study including 17 patients with PMAH treated surgically with adrenal-sparing surgery in a tertiary referral hospital, with a median follow-up of 41 months. Clinical, hormonal, and genetic parameters were evaluated before surgery and during follow-up. All patients had at least 1 radiological examination before and after the procedure. Results: Among the 17 patients, all but 1 patient had complete hypercortisolism control, and 12 recovered normal adrenal function after surgery. Significant improvement in clinical parameters was observed: weight loss (P = .004); reduction of both systolic (P = .001) and diastolic (P = .001) blood pressure; and reduction in the number of antihypertensive drugs (P < .001). Intra-, peri-, and postoperative complications were not observed. Conclusion: Adrenal-sparing surgery is a safe and feasible procedure to treat patients with PMAH, providing a substantial chance of hypercortisolism control without the disadvantages of lifetime corticosteroid replacement. (C) Endocrine Society 2020.engopenAccessPMAHpartial adrenalectomyhypercortisolismadrenal surgeryARMC5cushings-syndromesubclinical hypercortisolismunilateral adrenalectomyarmc5 mutationsrecoveryefficacydiseaseA New Insight into the Surgical Treatment of Primary Macronodular Adrenal HyperplasiaarticleCopyright ENDOCRINE SOC10.1210/jendso/bvaa083Endocrinology & Metabolism2472-1972