From the analysis of 23 cases of adrenal Cushing's syndrome, consisted of 19 cases of unilateral adrenocortical, adenoma and 4 cases of unilateral adrenocortical carcinoma, who underwent operation from August 1983 to July 11993 at Department of
Surgery,
Seoul National University Hospotal, authors had the following results.
The most prevalent age groups were 3rd and 4th decades and mean age was 35.7 years. The male to female ratio was 1:3.6. The most common symptoms were moon face and truncal obesity in 20 cases(87.0%). The biochemical studies, 24-hour urine
17-ketosteroid(KS) showed the most significant difference between benign and malignant lesions, being within normal range in benign lesion and elevated in malignant lesions. Abdominal computerized tomography and abdominal ultrasonography could
localize
the lesion in all cases with were checked. The size and weight of the cortical adenomas were 3.4±1.0cm and 2.7±5.8gm, and those of the carcinoma were 7.4±3.0cm and 139.3±128.7gm.
Unilateral subtotal adrenalectomy was done for 9 cases with adenoma and unilateral total adrenalectomy was done for 10 cases with adenoma and 2 cases with carcinomas which had distant metastases to the liver, lung and bones. For the 2 cases with
cortical carcinoma invaded to the adjacent organs. unilateral total adrenalectomy and resection of the invaded organs wer done. Postoperative period for normalization of serum cortisol were 6.06 months in adenomas and 1 and 3 month in carcinomas
without
distant metastasis, repectively.
In conclusion, the possibility of malignancy should be considered in cases of large adrenal mass with significantly elevated 17-KS. Either abdominal CT or ultrasonography was effective in localization of adrenocortical tumors. In cortical
carcinomas,
despite the distant metastasis, surgical treatment is recommended because it has benificial effect on postoperative management. There was no difference in postoperative results between unilateral total and subtotal adrenalectomy for the benign
lesions.
With the surgical therapy for the unilateral adrenal cortical adenomas, about six months of postoperative replacement of steroid would be needed.
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