Waiting for change: Symptom resolution after adrenalectomy for Cushing's syndrome

Background: The debilitating symptoms and physical changes from Cushing's syndrome may resolve after treatment, but the time course to resolution is not well established. Methods: Between February 1995 and May 2007, 60 patients underwent adrenalectomy for Cushing's syndrome. Pre-operative and operative variables were collected from a prospective database. Long-term follow-up was obtained via patient survey. Results: Unilateral adrenalectomy was performed in 53% and a bilateral adrenalectomy in 47% of patients. Median time to diagnosis was 24 months (range, 1-384). Three percent had intra-operative complications, and 28% developed post-operative complications. Steroids were required post-operatively for a median of 30 months after unilateral adrenalectomy (range, 0-96). At a median follow-up of 3.7 years (range, 0-13.3), 85% of patients are still alive. The majority of the physical changes resolved after adrenalectomy. The time to symptom resolution varied from a few weeks to up to 4 years. Most of the physical changes resolved by a mean of 7-9 months after surgery. Quality of life improved in 78% of patients, with 68% improving dramatically (P < .001). Conclusion: Adrenalectomy can provide excellent palliation of the symptoms of cortisol excess and can dramatically improve patient quality of life, but both patients and physicians must know that these changes may take years.