ADRENAL AUTOTRANSPLANTATION IN CLINIC.
Annotatsiya
P660 Aims: Effectiveness of staged bilateral adrenalectomy with autotransplantation of adrenal tissue in patients with ACTH-dependent Cushing’s disease had been analyzed. Methods: Bilateral staged adrenalectomy with autotransplantation was carried out in patients, after first unilateral adrenalectomy had been ineffective. Intraoperative autotransplantatnbion of native adrenal gland tissue was performed in 9 patients, including 2 children. Small cuts of pieces of hyperplasized adrenal tissue in mass 2-3 grams were placed into right forearm subcutaneously. Plasma cortisol concentration was evaluated in right and left cubital veins to compose each other in different periods after surgery for controlling functional activity of graft. Other indirect factor of graft activity like corticoid requirement, clinical features, plasma ACTH content were analyzed as well. Results: Significantly increased cortisol content in right cubital vein comparing to left cubital vein have been revealed on 7th day after autotransplantation of adrenal tissue (401 nM/l vs. 270 nM/l respectively, P<0,05). This difference was kept till 5 months after surgery and then decreased. At 6th month after surgery these values were 248±14,4 nmol/L vs. 209±8,3 nmol/L (P<0,05) and at 12th month 193±9,8 nmol/L vs. 172±10,1 nmol/L (P>0,05) respectively. The clinical conditions of the patients were considerably improved (weight, appearance, arterial pressure, mood etc.). During 5-6 months after surgery patients were administered minimal dose of hormonal replacement therapy of prednisolone in dose 2,5-5 mg/day (vs. to daily need 7,5-10 mg/day). There was no necessity for mineralocorticoid administration. After 6 months dose of prednisolone was increased up to 7,5-10 mg/day and mineralocorticoids (9a-ftorcortisol 0.1-0.05 mg/D) were administrated due to sighs of chronic adrenal insufficiency developed. Plasma ACTH concentration remained high after surgery relative to preoperative value. In this matter patients needed further evaluation and treatment. Conclusions: It has been concluded that bilateral adrenalectomy in some patients with ACTH-dependent Cushing’s disease still remains one of main method of therapy and intraoperative autotransplantation of adrenal tissue can partly cover the patient’s needs for glucocorticoids, while contributing adequate functional activity of pituitary-adrenal axis after surgery.