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The purpose of this review article is to provide a historical synopsis of surgery for CS, review a recent 10\u2010year period of operative management at a tertiary care facility, and to outline a practical approach to diagnosis and management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>From 1996 to 2005, 298 patients underwent 322 operative procedures for CS at Mayo Clinic, Rochester, Minnesota. A retrospective chart review was carried out. Data was gathered regarding demographics, preoperative assessment, procedures performed, and outcomes. Data are presented as counts and percentages. Five\u2010year survival rates were calculated where applicable by the Kaplan\u2010Meier method. Statistical analysis was carried out with SAS, version 9 (SAS Institute, Inc., Cary, NC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Two\u2010hundred thirty\u2010one patients (78%) had ACTH\u2010dependent CS and 67 patients (22%) had ACTH\u2010independent CS. One\u2010hundred ninety\u2010six patients (66%) had pituitary\u2010dependent CS and 35 patients (12%) had ectopic ACTH syndrome. Fifty\u2010four patients (18%) had cortisol\u2010secreting adenomas, 10 patients (3%) had cortisol\u2010producing adrenocortical carcinomas, and 1% had other causes. Cure rates for first time pituitary operations (transsphenoidal, sublabial, and endonasal) were 80% and 55% for reoperations. Most benign adrenal processes could be managed laparoscopically. Five\u2010year survival rates (all causes) were 90%, 51%, and 23% for adrenocortical adenomas, ectopic ACTH syndrome, and adrenocortical carcinomas, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Surgery for CS is highly successful for pituitary\u2010dependent CS and most ACTH\u2010independent adrenal causes. Bilateral total adrenalectomy can also provide effective palliation from the ravages of hypercortisolism in patients with ectopic ACTH syndrome and for those who have failed transsphenoidal surgery. Unfortunately, to date, adrenocortical carcinomas are rarely cured. Future successes with this disease will likely depend on a better understanding of tumor biology, more effective adjuvant therapies and earlier detection. Clearly, IPSS, advances in cross\u2010sectional imaging, along with developments in transsphenoidal and laparoscopic surgery, have had the greatest impact on today\u2019s management of the complex patient with CS.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-007-9387-6","type":"journal-article","created":{"date-parts":[[2008,1,14]],"date-time":"2008-01-14T13:29:15Z","timestamp":1200317355000},"page":"659-677","source":"Crossref","is-referenced-by-count":67,"title":["Surgery for Cushing\u2019s Syndrome: An Historical Review and Recent Ten\u2010year Experience"],"prefix":"10.1002","volume":"32","author":[{"given":"John R.","family":"Porterfield","sequence":"first","affiliation":[{"name":"Department of Surgery Mayo Clinic and Mayo Foundation 200 First Street, S.W 55905 Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey B.","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Surgery Mayo Clinic and Mayo Foundation 200 First Street, S.W 55905 Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"William F.","family":"Young","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, Metabolism, and Nutrition Mayo Clinic and Mayo Foundation 200 First Street, S.W 55905 Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John T.","family":"Chow","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, Metabolism, and Nutrition Mayo Clinic and Mayo Foundation 200 First Street, S.W 55905 Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond S.","family":"Fryrear","sequence":"additional","affiliation":[{"name":"Department of Surgery Mayo Clinic and Mayo Foundation 200 First Street, S.W 55905 Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon A.","family":"van Heerden","sequence":"additional","affiliation":[{"name":"Department of Surgery Mayo Clinic and Mayo Foundation 200 First Street, S.W 55905 Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R.","family":"Farley","sequence":"additional","affiliation":[{"name":"Department of Surgery Mayo Clinic and Mayo Foundation 200 First Street, S.W 55905 Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John L. 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