علاج متلازمة كوشينغ في اضطرابات الغدة الكظرية الثنائية

References

DOI: 10.1210/jc.2015-1818

• We recommend surgical resection of bilateral adrenal disorders and suggest medical therapy to block aberrant hormone receptors for bilateral macronodular adrenal hyperplasia (BMAH).
• Laparoscopic bilateral adrenalectomy is the definitive treatment of choice and is curative in most cases of primary pigmented nodular adrenal disease, regardless of age.
• Bilateral adrenalectomy, generally via the laparoscopic route, is the surgical treatment of choice, although some advocate for selective removal of the larger adrenal in older patients in whom nonfunctional tumors are a possibility, especially if there is only a single nodule on each side.
• BMAH can be treated by an appropriate antagonist if aberrant receptors are demonstrated that clearly couple to cortisol release, but the detailed workup of such patients is a research undertaking beyond the scope of these guidelines.