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• W2980432884 endingPage "341" @default.
• W2980432884 startingPage "334" @default.
• W2980432884 abstract "Aim. To present specific aspects of adrenalectomy for Cushing's syndrome (CS) by introducing well established aspects (do's) and less known aspects (don'ts). Material and Method. This is a narrative review. Results. The do's for laparoscopic adrenalectomy (LA) are the following: it represents the gold standard for secretor and non-secretor adrenal tumors and the first line therapy for CS with an improvement of cardio-metabolic co-morbidities; the success rate depending on the adequate patients' selection and the surgeon's skills. The don'ts are large (>6-8 centimeters), locally invasive, malignant tumors requiring open adrenalectomy (OA). Robotic adrenalectomy is a new alternative for LA, with similar safety and conversion rate and lower pain drugs use. The don'ts are the following: lack of randomized controlled studies including oncologic outcome, different availability at surgical centers. Related to the sub-types of CS, the do's are the following: adrenal adenomas which are cured by LA, while adrenocortical carcinoma (ACC) requires adrenalectomy as first line therapy and adjuvant mitotane therapy; synchronous bilateral adrenalectomy (SBA) is useful for Cushing's disease (only cases refractory to pituitary targeted therapy), for ectopic Cushing's syndrome (cases with unknown or inoperable primary site), and for bilateral cortisol producing adenomas. The less established aspects are the following: criteria of skilled surgeon to approach ACC; the timing of surgery in subclinical CS; the need for adrenal vein catheterization (which is not available in many centers) to avoid unnecessary SBA. Conclusion. Adrenalectomy for CS is a dynamic domain; LA overstepped the former OA area. The future will improve the knowledge related to RA while the cutting edge is represented by a specific frame of intervention in SCS, children and pregnant women. Abbreviations: ACC = adrenocortical carcinoma, ACTH = Adrenocorticotropic Hormone, CD = Cushing's disease, CS = Cushing's syndrome, ECS = Ectopic Cushing's syndrome, LA = laparoscopic adrenalectomy, OA = open adrenalectomy, PA = partial adrenalectomy, RA = robotic adrenalectomy, SCS = subclinical Cushing' syndrome." @default.
• W2980432884 created "2019-10-25" @default.
• W2980432884 creator A5002322873 @default.
• W2980432884 creator A5011371139 @default.
• W2980432884 creator A5047040606 @default.
• W2980432884 creator A5053834003 @default.
• W2980432884 date "2016-12-09" @default.
• W2980432884 modified "2023-10-16" @default.
• W2980432884 title "Adrenalectomy for Cushing's syndrome: do's and don'ts." @default.
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