In patients with adrenal adenoma, unilateral adrenalectomy gradually leads to the disappearance of the signs and symptoms of Cushing's syndrome, and these patients have excellent long-term survival. The first clinical and metabolic changes disappear within 4 to 6 weeks. Muscular weakness also disappears, and female patients may become pregnant. Resolution of the cutaneous alterations, including hirsutism and hypertension, takes longer. Obesity and the abdominal fat distribution regress slowly, and it often takes 12 months for the physical appearance of these patients to recover (Fig. 70-7).

Recovery is slower after bilateral adrenalectomy for pituitary-dependent Cushing's syndrome. Moreover, some patients remain hypertensive (30%) with diabetes (20%) and obesity (20%).30 These patients may have a reduced working capacity, but their survival is similar to that seen in the general population.14 In 30% of cases, Nelson's syndrome is a problem. All patients after bilateral adrenalectomy must undergo periodic check-ups. Supplemental steroid treatment must be taken at times of stress.

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