Persistent or Recurrent Cushing's Syndrome After "Total" Adrenalectomy

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Abstract
Following "total" adrenalectomy Cushing's syndrome persisted in two patients and recurred in two others after remitting in each for three to four years. Three of the four patients had undergone a second surgical search for residual adrenal tissue but cortisolism continued. Employing a recently developed method, these patients were photoscanned after administration of 131I-19-iodocholesterol. In each case, an increased concentration of radioactivity was observed in the right suprarenal fossa. These results suggest that persistence or recurrence of Cushing's syndrome following total adrenalectomy is usually due to incomplete removal of the right adrenal gland. The situation has posed a difficult problem for the surgeon who has had to search blindly through scar tissue for residual adrenal tissue. Ability to demonstrate with radiocholesterol the site of the remaining functioning adrenal tissue should alleviate this problem.