Experience in the treatment of patients with ACTH-independent macronodular bilateral adrenal hyperplasia

Abstract

Aim to determine the optimal tactics for the examination and treatment of patients with macronadular bilateral adrenal hyperplasia. Material and methods. The study included 11 patients with macronodular bilateral adrenal hyperplasia (main group). To compare biochemical parameters, the results of 26 healthy people were studied (control group). Results. The patients with macronodular bilateral adrenal hyperplasia were characterized by deficiency of 11-hydroxylase, 21-hydroxylase, 11-hydroxysteroid dehydrogenase type 2 and increased activity of 5-reductase compared with the control group. The optimal treatment for these patients is unilateral adrenalectomy. A comparative selective blood sampling from the central veins of the adrenals is necessary to select the side of intervention in patients with bilateral macronodular adrenal hyperplasia with ACTH-independent Cushing's syndrome. Conclusion. The first step in the treatment of patients with bilateral macronodular adrenal hyperplasia with ACTH-independent Cushing's syndrome is unilateral adrenalectomy, which reduces the risk of developing adrenal insufficiency and subsequent hormone replacement therapy.

Keywords

• cushing's syndrome
• macronodular bilateral adrenal hyperplasia
• endogenous hypercorticism
• comparative selective blood sampling from the adrenal veins
• adrenal resection