Results and long-term follow up after unilateral adrenalectomy for cortisol secreting adrenal tumors

Background: Untreated hypercortisolism is a fatal state; it causes functional disability, with negative effects on personal, social and working life. Even after successful treatment, clinical recovery is slower than biochemical one, but data about the long-term results, well-being and working capacity after surgery are scarce. The aim of this retrospective study was to evaluate the long-term outcome of patients treated for ACTH-independent hypercortisolism by analyzing the objective clinical results, the survival, the subjective well-being and quality of life after surgery. Methods: From January 1980 to December 2000, 50 patients (4 men, 46 women, median age 44 years, range 23-69 years) underwent unilateral adrenalectomy because of adrenal adenoma causing ACTH-independent hypercortisolism. Objective clinical data were recorded prior and after adrenalectomy. All the surviving patients were asked to fill a questionnaire regarding symptoms and the subjective physical, psychological, social and working recovery after surgery. Results: After surgery 100% of patients was considered biochemically cured. At a median follow-up of 129 months (range 13-264 months) three patients was dead. An objective recovery was observed in most of cases: hypertension in 90%, morbid obesity in 100%, skin and psychic changes in 70% and 90% respectively. Subjectively, surviving patients stated a full recovery from disease in 100% of cases; a physical recovery in 92%, a psychological and social improvement in 70% and 64%; recovery of working ability in 96%. Conclusions: The mortality rate among patients treated for ACTH-independent hypercortisolism was moderately but not significantly increased compared with that of the general population. At long term follow-up most of symptoms disappeared; subjective health and working ability were often regained after surgical treatment.