A challenging case of laparoscopic synchronous bilateral adrenalectomy for Cushing's disease. Case report

INTRODUCTION: Laparoscopic adrenalectomy is a treatment option in patients with Cushing's syndrome. Preoperative comorbities as well as surgical and anesthesiological difficulties can make the procedure challenging. PRESENTATION OF THE CASE: We present the case of a 53-year-old obese man diagnosed with Cushing's syndrome, also suffering from other endocrine pathologies, neurofibromatosis type 2, cardiomiopathy with severe hypertrophy and diastolic dysfunction, deep vein thrombosis (DVT) and obstructive sleep apnea syndrome (OSAS). After multidisciplinary team discussion of the case, the patient underwent laparoscopic synchronous bilateral adrenalectomy. The laparoscopic approach was a part of a balanced enhanced recovery program which resulted in uneventful discharge in 4 days. CONCLUSION: Laparoscopic synchronous bilateral adrenalectomy is feasible and effective and should be considered also in patients with wide preoperative comorbidities and challenging intraoperative management, as long as the patient is meticulously studied preoperatively. An approach including a multidisciplinary team discussion is recommended.