Long-term Outcomes of Unilateral Adrenalectomy in Patients with Dominant-side Adrenal Hyperplasia
Haim Paran,, Guy Elad,, Sydney Benchetrit,, Igal Griton,, Ilana Haas,, Ori Yaslowitz,, Pavel Shmulevsky
Citation Information :
Paran, H, Elad, G, Benchetrit, S, Griton, I, Haas, I, Yaslowitz, O, Shmulevsky P. Long-term Outcomes of Unilateral Adrenalectomy in Patients with Dominant-side Adrenal Hyperplasia. World J Endoc Surg 2017; 9 (2):37-40.
Usual treatment for patients with aldosterone-producing adrenal adenoma is adrenalectomy, whereas adrenal hyperplasia is generally treated medically. Selective adrenal venous sampling (AVS) has been adopted to differentiate between adenoma and hyperplasia. A previous ratio used in our institution for the diagnosis of adenoma proved to be too low. As a result, a disproportionate number of patients with a preoperative diagnosis of adenoma were operated and subsequently found to have hyperplasia.
Materials and methods
This prospective study evaluated the long-term outcomes of unilateral laparoscopic adrenalectomy in the setting of lateralizing aldosterone hypersecretion caused by adrenal hyperplasia.
Results
Twelve patients with unilateral excess aldosterone production due to hyperplasia underwent dominant side adrenalectomy. Long-term follow-up (mean 12 years) of these patients showed that blood pressure decreased from a mean of 163.4 ± 17.5/100 to 131.5 ± 9.7/80 mm Hg (p < 0.05), and the number of antihypertensive drugs decreased from 4.3 ± 0.7 to 2.2 ± 0.9 (p < 0.05). Mean potassium level increased from 3.7 to 4.2 mEq/L and the plasma aldosterone level decreased from 26.5 to 10.1 ng/dL.
Conclusion
Dominant side adrenalectomy in patients with primary aldosteronism (PA) due to hyperplasia results in long-term clinical improvement. This procedure should be considered in selected patients with lateralization confirmed by venous sampling.
How to cite this article
Paran H, Elad G, Benchetrit S, Griton I, Haas I, Yaslowitz O, Shmulevsky P. Long-term Outcomes of Unilateral Adrenalectomy in Patients with Dominant-side Adrenal Hyperplasia. World J Endoc Surg 2017;9(2):37-40.
Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2008 Sep;93(9):3266-3281.
Prevalence of primary hyperaldosteronism in resistant hypertension: a retrospective observational study. Lancet 2008 Jun;371(9628):1921-1926.
Hyperaldosteronism among black and white subjects with resistant hypertension. Hypertension 2002 Dec;40(6):892-896.
Primary hyperaldosteronism secondary to unilateral adrenal hyperplasia: an unusual cause of surgically correctable hypertension: a review of 30 cases. World J Surg 2007 Jan;31(1):72-79.
Long-term results of adrenalectomy in patients with aldosterone-producing adenomas: multivariate analysis of factors affecting unresolved hypertension and review of the literature. Am Surg 2005 Oct;71(10):864-869.
Unilateral hypersecretion of aldosterone associated with adrenal hyperplasia as cause of primary aldosteronism. Clin Exp Hypertens A 1983;5(10):1635-1658.
Identification of the etiology of primary aldosteronism with adrenal vein sampling in patients with equivocal computed tomography and magnetic resonance findings: results in 104 consecutive cases. J Clin Endocrinol Metab 2001 Mar;86(3):1083-1090.
Screening for primary aldosteronism without discontinuing hypertensive medications: plasma aldosterone-renin ratio. Am J Kidney Dis 2001 Apr;37(4):699-705.
Unilateral adrenal hyperplasia causing primary aldosteronism: limitations of I-131 norcholesterol scanning. Am J Hypertens 2002 May;15(5):459-464.
Role for adrenal venous sampling in primary aldosteronism. Surgery 2004 Dec;136(6):1227-1235.
Primary aldosteronism: diagnosis, localization, and treatment. Ann Intern Med 1979 Mar;90(3):386-395.
Dynamic testing with high-dose adrenocorticotrophic hormone does not improve lateralization of aldosterone oversecretion in primary aldosteronism patients. J Hypertens 2006 Feb;24(2):371-379.
Unilateral adrenal hyperplasia: a novel cause of surgically correctable primary hyperaldosteronism. Surgery 2012 Dec;152(6):1248-1255.
Clinical outcomes of laparoscopic adrenalectomy for lateralizing nodular hyperplasia. Surgery 2005 Dec;138(6):1009-1016; discussion 1016-1017.