TOTAL BILATERAL ADRENALECTOMY FOR ADRENAL CORTICAL HYPERFUNCTION
William E. Abbott, M.D. William McK. Jefferies, M.D. Stanley Levey, Ph.D. and Harvey Krieger, M.D., ClevelandThe primary disturbance responsible for the signs and symptoms present in Cushing's syndrome is believed to be excessive adrenocortical activity. This may result from hyperfunctioning tumor or bilateral hyperplasia of the adrenal cortices. If the cause is a tumor, surgical removal is obviously indicated. In cases due to hyperplasia, however, the treatment of choice has not been established. Prior to the availability of cortisone, attempts at subtotal or total adrenalectomy were fraught with serious hazards of postoperative adrenal insufficiency and resulted in a prohibitive postoperative mortality rate. With the use of cortisone or hydrocortisone, patients can be satisfactorily carried through the operative and immediate postoperative period and may live reasonably normal lives in the complete absence of adrenal tissue, provided a suitable maintenance regimen is followed; hence,
CLINICAL NOTES. JAMA. 1954;156(12):1168–1171. doi:10.1001/jama.1954.02950120042013
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