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Scoring system to quantify clinical resolution of Cushing syndrome after adrenal surgery


 
 
 Adrenalectomy for Cushing syndrome is a rare operation. There is no disease-specific tool to quantify the severity of symptoms in such patients.
 
 
 
 Retrospective analysis of consecutive unselected patients who underwent adrenal surgery for Cushing syndrome. A standard questionnaire was used to assess symptoms on a visual analogue scale (VAS, <10=very poor, >90=excellent) or as categorical categories for severity of symptoms.
 
 
 
 Between Jan2016-Aug2021, 21 patients (10M:11F, median age 56 years) underwent unilateral (n=18) or bilateral (n=3) adrenalectomy for Cushing syndrome caused by adrenal adenoma (n=15), adrenocortical cancer (n=3) or ectopic ACTH secretion (n=3). Patients had a median admission of 3 days (range 1–20 days). Most common perioperative complications were related to thrombotic events. Patients with ectopic-ACTH syndrome due to metastatic neuroendocrine tumours are alive at 11–66 months after their operation. Patients with adrenocortical cancer were not contacted.
 Eighteen patients were contacted by post at median 37 months (range 3–66 months) postop. Assessment of general health on VAS improved from median 25 to 72.5 (out of 100), symptoms score decreased from 17.5 to 6 (p<0.05) through improvement in scores for muscle power and physical signs. Length of time need for recovery ranged from a minimum of 3–6 months (n=3) to over 1–2 years (n=4). Three patients had emergency admissions with Addisonian crisis.
 
 
 
 These data will inform patients about the expected timeline for symptoms resolution after adrenalectomy for Cushing syndrome. A multicentre prospective cohort study should use this new score system to quantify severity of symptoms associated with hypercortisolism.
