April 1972

Recurrent Cushing's Disease Following "Total" Adrenalectomy

Author Affiliations

Birmingham, Ala

From the Division of Endocrinology, Department of Medicine, University of Alabama School of Medicine, Birmingham; and Birmingham Veterans Administration Hospital (Drs. Siegal and Owen).

Arch Intern Med. 1972;129(4):642-647. doi:10.1001/archinte.1972.00320040118016

Although Cushing's disease is thought to be primarily a hypothalamic or pituitary disorder or both, therapy has traditionally been directed at the adrenal glands. Treatment by subtotal adrenalectomy has been largely abandoned because of the high rate of recurrence, approximately 30%.1 In view of the currently accepted mechanism of this disorder, any remaining adrenal tissue either left purposely or inadvertently would be exposed to continued stimulation by adrenocorticotropic hormone (ACTH). As a result, total bilateral adrenalectomy is the usual therapy at the present time, but because of technical surgical problems, or the presence of ectopic adrenal tissue, this procedure does not guarantee total remission. As far as we have been able to ascertain, there have been only four cases reported of recurrence after a presumed total adrenalectomy.2,3

We have recently observed four patients with recurrence or persistence of hypercortisolism following seemingly total adrenalectomy.

Methods  Following recognition of the

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