Document Detail


Clinical outcome after laparoscopic adrenalectomy for primary hyperaldosteronism: the role of pathology.
MedLine Citation:
PMID:  20083287     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Primary hyperaldosteronism (PHA) is potentially curable by laparoscopic unilateral adrenalectomy (LUA). Pre-operative assessment rarely differentiates adrenal adenoma from hyperplasia. This study aimed to evaluate the results of LUA for PHA according to pathologic findings when an adrenal mass was identified unequivocally on a CT scan.
METHODS: A retrospective analysis of LUA for PHA from July 1997 to May 2008 was performed. The minimal follow-up was 6 months. We considered hypertension to be cured in patients with normal blood pressure without antihypertensive medication (AM). Improvement was defined by a decrease of AM.
RESULTS: Fifty-seven patients were included. Thirty-six patients (63%) had an adrenal adenoma and 21 (37%) a hyperplasia. The median follow-up was 6.4 years. Hypokalemia was cured in all patients, 33 patients (58%) were cured of their hypertension, and 23 (96% of the 24 noncured patients) were improved with a reduction of the number of AM. Predictive factors for a cure were: gender, age, BMI, duration of hypertension, number of pre-operative AMs, pre-operative arterial systolic blood pressure, creatinin and plasma renin activity. Postoperative predictive factors were pathology, size of the mass, and systolic and diastolic arterial pressures. In the multivariate analysis the only remaining factor was pathology.
CONCLUSION: LUA for PHA cured all patients from their hypokalemia and cured or improved hypertension in 98%. Pre-operative diagnosis of adenoma or hyperplasia is not mandatory but it is important to warn patients that hypertension can persist after adrenalectomy, especially in case of adrenal hyperplasia, although this hypertension is easier to control.
Authors:
Christophe Trésallet; Harika Salepçioglu; Gaëlle Godiris-Petit; Catherine Hoang; Xavier Girerd; Fabrice Menegaux
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Publication Detail:
Type:  Journal Article     Date:  2010-01-18
Journal Detail:
Title:  Surgery     Volume:  148     ISSN:  1532-7361     ISO Abbreviation:  Surgery     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-06-15     Completed Date:  2010-07-01     Revised Date:  2011-07-18    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  129-34     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2010 Mosby, Inc. All rights reserved.
Affiliation:
Department of General, Digestive and Endocrine Surgery, Hôpital de la Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France. christophe.tresallet@psl.aphp.fr
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MeSH Terms
Descriptor/Qualifier:
Adrenalectomy*
Adult
Aldosterone / blood
Blood Pressure
Female
Follow-Up Studies
Humans
Hyperaldosteronism / pathology,  physiopathology,  surgery*
Laparoscopy*
Male
Middle Aged
Renin / blood
Retrospective Studies
Tomography, X-Ray Computed
Chemical
Reg. No./Substance:
52-39-1/Aldosterone; EC 3.4.23.15/Renin
Comments/Corrections
Comment In:
Surgery. 2011 Jun;149(6):852   [PMID:  21208633 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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