{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T02:48:33Z","timestamp":1781232513347,"version":"3.54.1"},"reference-count":60,"publisher":"Georg Thieme Verlag KG","issue":"03","funder":[{"name":"TF received funding by the Accelerating Excellence in Translational\n                        Science","award":["U54MD007598"],"award-info":[{"award-number":["U54MD007598"]}]},{"DOI":"10.13039\/100006545","name":"National Institute on Minority\n                        Health and Health Disparities","doi-asserted-by":"crossref","award":["MD000103"],"award-info":[{"award-number":["MD000103"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Diversity-Promoting Institution Drug Abuse Research Program","award":["R24DA017298"],"award-info":[{"award-number":["R24DA017298"]}]},{"DOI":"10.13039\/100005188","name":"California Tobacco-Related Disease Research\n                    Program","doi-asserted-by":"crossref","award":["251P003"],"award-info":[{"award-number":["251P003"]}],"id":[{"id":"10.13039\/100005188","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100005188","name":"California Tobacco-Related Disease Research\n                        Program","doi-asserted-by":"crossref","award":["28CP-0040"],"award-info":[{"award-number":["28CP-0040"]}],"id":[{"id":"10.13039\/100005188","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Horm Metab Res"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Bilateral adrenalectomy (BLA) is a treatment option for patients with\n                        Cushing\u2019s Disease (CD) if transsphenoidal pituitary surgery fails or\n                        is not a therapeutic option. For most patients, BLA eliminates endogenous\n                        glucocorticoid and mineralocorticoid production, but for a small number of\n                        patients, endogenous secretion of adrenal hormones from adrenal tissue\n                        continues or recurs, leading to signs and symptoms of hypercortisolism. If\n                        adrenal tissue is confined to the adrenal bed, it is considered adrenal\n                            remnant tissue, while if it is outside the adrenal bed, it is\n                        considered adrenal rest tissue. We retrospectively evaluated morning\n                        serum cortisol, nighttime serum cortisol, nighttime salivary cortisol, and\n                        24-h urine free cortisol on at least three occasions in 10 patients\n                        suspected of having endogenous cortisol production. Imaging of adrenal\n                        remnant tissue was also reviewed. Ten of 51 patients who underwent BLA\n                        during this time period had adrenal remnant\/rest tissue marked by\n                        detectable endogenous glucocorticoid production; 9 of the 10 patients had\n                        signs and symptoms of hypercortisolism. Localization and treatment proved\n                        difficult. We conclude that the incidence of adrenal remnant\/rest\n                        tissue in those undergoing BLA following unsuccessful pituitary surgery was\n                        12% although there may have been a selection bias affecting this\n                        prevalence. The first indication of remnant tissue occurrence is a reduction\n                        in glucocorticoid replacement with symptoms of hypercortisolism. If this\n                        occurs, endogenous cortisol production should be tested for by cortisol\n                        measurements using a highly specific cortisol assay while the patient is\n                        taking dexamethasone or no glucocorticoid replacement. Endocrinologists need\n                        to monitor the development of both adrenal remnant tissue and\n                        Nelson\u2019s syndrome following BLA.<\/jats:p>","DOI":"10.1055\/a-1253-2854","type":"journal-article","created":{"date-parts":[[2020,10,22]],"date-time":"2020-10-22T22:56:53Z","timestamp":1603407413000},"page":"161-168","source":"Crossref","is-referenced-by-count":4,"title":["High Prevalence of Adrenal Remnant Tissue in Patients Undergoing\n                    Bilateral Adrenalectomy for Cushing\u2019s Disease"],"prefix":"10.1055","volume":"53","author":[{"given":"Julian B.","family":"Wilson","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Metabolism, and Molecular Medicine, Charles\n                    R. Drew University of Medicine and Science, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohan","family":"Zopey","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Metabolism, and Molecular Medicine, Charles\n                    R. Drew University of Medicine and Science, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaimie","family":"Augustine","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Metabolism, and Molecular Medicine, Charles\n                    R. Drew University of Medicine and Science, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randolph","family":"Schaffer","sequence":"additional","affiliation":[{"name":"Department of Surgery, Scripps Green Hospital, La Jolla, CA,\n                    USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manfred","family":"Chiang","sequence":"additional","affiliation":[{"name":"Brookfield Surgical Associates, Brookfield, WI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore C.","family":"Friedman","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Metabolism, and Molecular Medicine, Charles\n                    R. Drew University of Medicine and Science, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,10,22]]},"reference":[{"key":"ref1","first-page":"642","volume-title":"The adrenal gland","author":"T C Friedman","year":"2015"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"1605","DOI":"10.1016\/S0140-6736(06)68699-6","article-title":"Cushing\u2019s syndrome","volume":"367","author":"J Newell-Price","year":"2006","journal-title":"Lancet"},{"key":"ref3","first-page":"489","volume-title":"The Adrenal Cortex","author":"P M Stewart","year":"2016"},{"key":"ref4","first-page":"281","article-title":"Cushing\u2019s syndrome: Epidemiology and developments in disease\n                    management","volume":"7","author":"S T Sharma","year":"2015","journal-title":"Clin Epidemiol"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1210\/jc.2008-0125","article-title":"The diagnosis of 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bilateral adrenalectomy in Cushing\u2019s\n                    syndrome: a systematic review","volume":"98","author":"K Ritzel","year":"2013","journal-title":"J Clin Endocrinol Metab"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"M23","DOI":"10.1530\/EJE-15-0265","article-title":"A critical reappraisal of bilateral adrenalectomy for ACTH-dependent\n                    Cushing\u2019s syndrome","volume":"173","author":"M Reincke","year":"2015","journal-title":"Eur J Endocrinol"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1001\/jama.1963.63710080025020a","article-title":"Cushing\u2019s syndrome with accessory adrenocortical tissue","volume":"186","author":"W R Chaffee","year":"1963","journal-title":"JAMA"},{"key":"ref11","first-page":"1211","article-title":"Residual adrenocortical function after bilateral adrenalectomy for\n                    pituitary-dependent Cushing\u2019s syndrome","volume":"75","author":"L 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Res"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1016\/j.surg.2009.06.057","article-title":"Comparison of laparoscopic transabdominal lateral versus posterior\n                    retroperitoneal adrenalectomy","volume":"146","author":"E Berber","year":"2009","journal-title":"Surgery"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"2629","DOI":"10.1245\/s10434-012-2352-0","article-title":"A comparative study of the transperitoneal and posterior retroperitoneal\n                    approaches for laparoscopic adrenalectomy for adrenal tumors","volume":"19","author":"C R Lee","year":"2012","journal-title":"Ann Surg Oncol"},{"key":"ref34","first-page":"P2","article-title":"Successful treatment of adrenal remnant tissue using alcohol ablation in a\n                    patient with episodic cushing disease","volume":"93","author":"J Augustine","year":"2011","journal-title":"Endocrine Soc (Abstract)"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1055\/s-0030-1263128","article-title":"High prevalence of normal tests assessing hypercortisolism in subjects with mild\n                    and episodic Cushing\u2019s syndrome suggests that the paradigm for diagnosis\n                    and exclusion of Cushing\u2019s syndrome requires multiple testing","volume":"42","author":"T C Friedman","year":"2010","journal-title":"Horm Metab Res"},{"key":"ref36","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1210\/jc.2017-02020","article-title":"Variability of late-night salivary cortisol in Cushing disease: A prospective\n                    study","volume":"103","author":"Z Sandouk","year":"2018","journal-title":"J Clin Endocrinol Metab"},{"key":"ref37","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1111\/cen.12259","article-title":"High variability in baseline urinary free cortisol values in patients with\n                    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