Minimally invasive management of primary bilateral macronodular adrenal hyperplasia (PBMAH): unilateral, bilateral adrenalectomy or sparing surgery debulking?

Abstract

Clinical case: a 51-year-old female patient, with a history of controlled type 2 Diabetes mellitus, reported diaphoresis, headache, fine tremors of 6 months' duration, grade I obesity, stretch marks on the abdominal wall and cortisol of 1189 μg/dL. A CT scan showed an increase in the size of both adrenal glands. Patient with clinical data of Cushing's syndrome, it was decided to perform laparoscopic left adrenalectomy, without complications. During follow-up, there was a significant decrease in cortisol and she was asymptomatic with significant improvement.

Relevance: primary bilateral macronodular adrenal hyperplasia (PHAMBP) is a rare cause of Cushing's syndrome less than 2 % and is often diagnosed by bilateral adrenal incidentalomas with hypercortisolism. Characterized by bilateral benign adrenal macronodules larger than 1 cm responsible for elevated cortisol levels. In this report we describe a case of this condition undergoing unilateral laparoscopic adrenalectomy.

Clinical implications: the importance lies in a multidisciplinary approach to make a correct diagnosis, to avoid the progression of symptoms with the possibility of clinical and biochemical remission with adrenalectomy.

Conclusions: unilateral resection of the largest adrenal gland can result in clinical and biochemical remission in >90 % of cases, with laparoscopic adrenalectomy being the treatment of choice.