scholarly journals Bilateral adrenalectomy in the 21st century: when to use it for hypercortisolism?

2016 ◽  
Vol 23 (2) ◽  
pp. R131-R142 ◽  
Author(s):  
Carole Guerin ◽  
David Taieb ◽  
Giorgio Treglia ◽  
Thierry Brue ◽  
André Lacroix ◽  
...  

Therapeutic options available for the treatment of Cushing's syndrome (CS) have expanded over the last 5 years. For instance, the efficient management of severe hypercortisolism using a combination of fast-acting steroidogenesis inhibitors has been reported. Recent publications on the long-term efficacy of drugs or radiation techniques have also demonstrated low toxicity. These data should encourage endocrinologists to reconsider the place of bilateral adrenalectomy in patients with ACTH-dependent aetiologies of CS; similarly, the indication of bilateral adrenalectomy is reassessed in primary bilateral macronodular adrenal hyperplasia. The objective of this review is to compare the efficacy and side effects of the various therapeutic options of hypercortisolism with those of bilateral adrenalectomy, in order to better define its indications in the 21st century.

1987 ◽  
Vol 27 (1) ◽  
pp. 46
Author(s):  
D.S. Crowe

The changing sociological scene places greater emphasis today on self-fulfilment psychology and individual expectations, often at the expense of responsibility in relationships. This, coupled with greater demands on staff (especially on managers of corporations) places, at times, unrealistic demands on normally stable relationships, particularly in a marriage. The result is increased family tension, often resulting in marriage breakdown with significant scarring of partners and children; those individuals, so affected, suffer reduced productivity in their work roles.As we approach the 21st century, there is emphasis, in the management of corporations, on innovation and cost efficiency, thus placing greater pressure on individual staff.This paper takes the position that corporations, in their own self-interest and in the interest of staff, need to assess the impact of their current policies on not only their staff but also on staff families. While maintaining that it remains the single responsibility of individuals to make decisions on managing, effectively, their corporate/private lives, the author supports the proposal of others (Evans and Bartolome, 1980) that corporations' policies should help, not hinder, the process.Corporations which continue to ignore these considerations will incur long term consequences with significant impact on productivity and efficient management, aside from possible disastrous impact on their staff and families.Corporations in Australia are taking steps to address this situation but much more needs to be done. This was highlighted in the March 1985 'Middle Management' course with its associated Spouses Programme presented jointly by Australian Mineral Foundation and The Australian Administrative Staff College.Effective communication is at the heart of the matter, but no amount of training on this subject will bear fruit unless there is an associated commitment by executives to improve the effectiveness of their communication process, both in their corporate and family roles.


Lung ◽  
2014 ◽  
Vol 193 (1) ◽  
pp. 105-112 ◽  
Author(s):  
Mona Lichtblau ◽  
Dominik Harzheim ◽  
Nicola Ehlken ◽  
Alberto Marra ◽  
Fabiola Pena Pinado ◽  
...  

Author(s):  
Valeria B. Campos ◽  
Christine C. Dierickx ◽  
William A. Farinelli ◽  
Tai-Yuan D. Lin ◽  
Woraphong Manuskiatti ◽  
...  

2018 ◽  
Vol 103 (5) ◽  
pp. 1767-1778 ◽  
Author(s):  
Diana MacKay ◽  
Anna Nordenström ◽  
Henrik Falhammar

Abstract Context Management of congenital adrenal hyperplasia (CAH) involves suppression of the hypothalamic–pituitary–adrenal axis using supraphysiological doses of exogenous glucocorticoids. This can pose a challenge, with Cushing syndrome a frequent complication of adequate suppression. Bilateral adrenalectomy, with subsequent replacement of glucocorticoids and mineralocorticoids at physiological doses, has been proposed as an alternative therapeutic strategy. Objective To review the outcomes after bilateral adrenalectomy for CAH. Data Sources A systematic search of PubMed/MEDLINE and Web of Science, identifying relevant reports published up to 10 January 2018. Study Selection Case reports or case series were included if they reported individual patient data from patients with CAH who had undergone bilateral adrenalectomy. Data Extraction Information regarding the following was extracted: first author, country, sex, age at adrenalectomy, year of adrenalectomy, diagnosis, molecular abnormality, pre- and postoperative biochemistry, pre- and postoperative medications, pre- and postoperative body mass index, indication for adrenalectomy, surgical technique, gross and microscopic adrenal characteristics, follow-up duration, and short- and long-term postoperative outcomes. Data Synthesis We identified 48 cases of bilateral adrenalectomy for CAH, with patients aged from 4 months to 56 years at surgery. The most common indication for surgery was the inability to control hyperandrogenism/virilization and/or Cushing syndrome (n = 30; 62%). Most patients (n = 34; 71%) reported symptomatic improvement postoperatively, with some cases of short-term (n = 5; 10%) and long-term (n = 13; 27%) adverse outcomes. Conclusions Bilateral adrenalectomy for CAH appears to be a reasonable therapeutic option for carefully selected patients who have had unsatisfactory outcomes with conventional medical management.


Author(s):  
Alfonso Luca Pendolino ◽  
Glenis K. Scadding ◽  
Bruno Scarpa ◽  
Peter J. Andrews

Abstract Purpose Aspirin treatment after desensitization (ATAD) represents an effective therapeutic option suitable for NSAID-exacerbated respiratory disease (N-ERD) patients with recalcitrant disease. Intranasal administration of lysine-aspirin (LAS) has been suggested as a safer and faster route than oral ATAD but evidence for its use is less strong. We investigated nasal LAS therapy long-term efficacy based on objective outcomes, smell function, polyp recurrence and need for surgery or rescue therapy. Clinical biomarkers predicting response to intranasal LAS, long-term side effects and consequences of discontinuing treatment have been evaluated. Methods A retrospective analysis of a database of 60 N-ERD patients seen between 2012 and 2020 was performed in March 2021. They were followed up at 3-months, 1-, 2- and 3-years with upper and lower airway functions assessed at each follow-up. Results Higher nasal airflow and smell scores were found at each follow-up in patients taking LAS (p < 0.001 and p = 0.048 respectively). No influence of LAS on pulmonary function measurements was observed. Patient on intranasal LAS showed a lower rate of revision sinus surgery when compared to those who discontinued the treatment (p < 0.001). None of the variables studied was found to influence LAS treatment response. Conclusion Our study demonstrates the clinical effectiveness of long-term intranasal LAS in the management of N-ERD in terms of improved nasal airflow and olfaction and a reduced need for revision sinus surgery. Intranasal LAS is safe, being associated with a lower rate of side effects when compared to oral ATAD. However, discontinuation of the treatment at any stage is associated with a loss of clinical benefit.


Endocrine ◽  
2011 ◽  
Vol 41 (1) ◽  
pp. 160-161 ◽  
Author(s):  
Masanori Yoshida ◽  
Hiroshi Umeda ◽  
Shintaro Iwama ◽  
Seiko Nakayama ◽  
Misaki Miyata ◽  
...  

2021 ◽  
Vol 161 ◽  
pp. S1216
Author(s):  
A. de Haan ◽  
J. van Nes ◽  
P. Werker ◽  
J. Langendijk ◽  
R. Steenbakkers

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