Adrenal-Directed Treatment Options for Cushing’s Disease

Abstract

Adrenal-directed treatment for Cushing's disease should be considered when pituitary-directed treatment has not been successful. Bilateral adrenalectomy in this setting, although a secondary option, is a good treatment to decrease morbidity and mortality. Laparoscopic adrenalectomy is one of the most clinically important advances in the past two decades for the treatment of adrenal disorders. When compared to open adrenalectomy, laparoscopic adrenalectomy is equally safe, effective, and curative; it is more successful in shortening hospitalization and convalescence and has less long-term morbidity. The keys to successful laparoscopic adrenalectomy are appropriate patient selection, knowledge of anatomy, delicate tissue handling, meticulous hemostasis, and experience with the technique of laparoscopic adrenalectomy.