To review and discuss the diagnostic and surgical therapeutic methods of adrenocortical hyperplastic disease.
METHODS: A retrospective analysis was done to 180 adrenocortical
hyperplasia patients (74 males, 109 females, aged 6~76 (average 40.1). Studies were done to the relationship between patients' clinical characteristics, biochemical, endocrinological and imaging examination results, the
therapeutic effects.
RESULTS: Among all 180 cases, there are 107
Cushing disease (CD), 19 ectopic
adrenocorticotropin adrenal
hyperplasia (EAAH), 28
adrenocorticotropin independent macronodular adrenal
hyperplasia (
AIMAH), 4 primary pigmented nodular adrenocortical
hyperplasia (PPNAH), and 28 Idiopathic
Hyperaldosteronism (IHA). Twenty-four-hour urinary free
cortisol (24 h UFC) excretion of CD, EAAH,
AIMAH and PPNAH patients were 95.2~535.7 µg (average 287.6 µg), 24.8~808.2 µg (average 307.9 µg), 102.5~3127.0 µg (average 852.5 µg), and 243.8~1124.6 µg (average 564.3 µg). Both low and high-dose
dexamethasone suppression tests (DDST) were not suppressed in
AIMAH, PPNAH and EAAH groups, but HDDST was suppressed in CD group. CT thin scanning results of 180 patients all showed enlargements in the affected side adrenal gland. Unilateral
adrenalectomies were performed in 102
hypercortisolism cases. Local lesion excisions were done to 21 IHA patients. 57 patients had surgeries in both sides of the adrenal glands (39 bilateral total
adrenalectomies, 16 total
adrenalectomy in one side andsubtotal
adrenalectomy in the other, 2 bilateral subtotal
adrenalectomies). 106 (59%) patients were followed up for 4~158 (average 32) months.
CONCLUSION: Unilateral
adrenalectomy was the first choice for operable adrenocortical
hyperplasia patients. The operation mode for the other adrenal gland should be based on the type of
hyperplasia and clinical observation.