P31 - Bilateral adrenalectomy as primary surgical treatment modality for Cushing syndrome – 10 years’ experience from tertiary care centre

Background/Introduction Bilateral adrenalectomy (BLA) is often deemed as last resort in the management of patients with Cushing sundrome (CS). However, it is a lifesaving procedure in severe endogenous hypercortisolism and palliative therapy in those with metastatic disease. Data describing the utility of BLA as a primary surgical treatment modality in CS is sparse. Purpose We aimed to assess clinical, biochemical and follow-up parameters of patients with CS managed with BLA as primary surgical treatment modality over 10 years. Methods Ambispective observational study conducted in Department of Endocrinology and Metabolism, AIIMS, New Delhi. Patients diagnosed with CS and undergone BLA as primary surgical treatment modality between 2013-2023 were included and data analyzed. Results Seventeen patients were studied, all had ACTH dependent CS: EAS (n=7, 41%); CD (n=5, 29%) and non-localised (n=5, 29%). In the study population, median age was 28 yrs and Male: Female ratio was 1.12. Duration of symptoms ranged from 2-36 months. Hypertension was seen in 100% of patients followed by proximal myopathy and hyperpigmentation (n=16; 94% each). Hypokalemia was seen in 76% (n=13). Median basal 8 a.m. serum cortisol level was 55 mcg/dl, while median 8 a.m. plasma ACTH level was 116 pg/ml, contrasting with median basal 8 a.m. serum cortisol and 8 a.m. plasma ACTH of 26.7 mcg/dl and 76.4 pg/ml in a comparator group of CD (n= 76) who were subjected to TNTS as primary surgical therapy. Of those 7 patients with EAS, 6 had metastatic disease (3- Medullary thyroid carcinoma; 1- ovarian carcinoma; 1- Mediastinal NET; 1- bronchial carcinoid) and 5 of them succumbed to their illness. Of the 5 patients with Cushing disease, 2 patients had pituitary macroadenoma with parasellar extension. Bilateral adrenalectomy was opted in view of life-threatening lung infection in 2, severe depression with suicidal tendencies in 1 and severe hypokalemia with cutaneous infections in 2. Of the 5 patients in whom source was not localized at initial presentation, one developed features suggestive of Nelson syndrome. Conclusion(s) BLA is a reasonable treatment option in those with severe hypercortisolism,and metastatic disease. It offers definitive relief of hypercortisolaemia in women desiring pregnancy.