Document Detail


Factors influencing outcome of surgery for primary aldosteronism.
MedLine Citation:
PMID:  8645073     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To identify factors that influence the outcome of surgery for primary aldosteronism. DESIGN: A retrospective clinical series, with a mean follow-up of 106 months (range, 12-280 months), of 42 patients who underwent adrenalectomy for primary aldosteronism between the years 1970 and 1993. SETTING: All patients were operated on at the Boston University Medical Center Hospital. PATIENTS AND INTERVENTION: We reviewed the records of 22 women and 20 men, ranging in age from 25 to 68 years, who underwent adrenalectomy for primary aldosteronism. Tests performed for preoperative classification of the adrenal pathological abnormalities included adrenal venous sampling, postural stimulation test, iodocholesterol I 131 scintigraphy, and computed tomography. MAIN OUTCOME MEASURES: The surgical outcome was classified as follows: response, normal blood pressure measurement (< 160/95 mm Hg) without medication; incomplete response, normal blood pressure measurement with medication or blood pressure measurement greater than 160/95 mm Hg despite antihypertensive treatment. RESULTS: Twenty-five patients (60%) became normotensive following surgery. The following factors were associated with a complete response to adrenalectomy by univariate analysis: adenoma classification (odds ratio [OR] = 9.6, P = .002); preoperative response to spironolactone (OR = 8.3, P = .007); age younger than 44 years (OR = 6.2, P = .009); and duration of hypertension less than 5 years (OR = 5.1, P = .03). Response to spironolactone was predictive only in cases classified as adenoma (P = .004). Duration of hypertension showed a strong correlation with age (r = 0.62). Using stepwise logistic regression, adenoma pathological classification, response to spironolactone, and duration of hypertension less than 5 years contributed independently to a predictive model. Micronodular hyperplasia alone was associated with incomplete response. The presence of coexisting micronodular hyperplasia in patients with adenoma did not affect the odds for a complete response. Computed tomography for preoperative diagnosis of adenoma showed the same level of accuracy (75%) as that for postural stimulation test and iodocholesterol scintigraphy, but less than that for adrenal venous sampling (91%). CONCLUSIONS: The study showed that the main determinants of a surgical cure of hypertension in primary aldosteronism were presence of adenoma and preoperative response to spironolactone. We favor computed tomography as the initial test to establish preoperative diagnosis of adenoma because of its reproducibility and high specifity.
Authors:
O Celen; M J O'Brien; J C Melby; R M Beazley
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Archives of surgery (Chicago, Ill. : 1960)     Volume:  131     ISSN:  0004-0010     ISO Abbreviation:  Arch Surg     Publication Date:  1996 Jun 
Date Detail:
Created Date:  1996-07-15     Completed Date:  1996-07-15     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9716528     Medline TA:  Arch Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  646-50     Citation Subset:  AIM; IM    
Affiliation:
Section of Surgical Oncology, Boston University Medical Center Hospital, Mass, USA.
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MeSH Terms
Descriptor/Qualifier:
Adenoma / diagnosis,  surgery
Adrenal Gland Neoplasms / diagnosis,  surgery
Adrenal Glands / pathology
Adrenalectomy*
Adult
Aged
Blood Pressure
Female
Follow-Up Studies
Humans
Hyperaldosteronism / diagnosis,  surgery*
Hyperplasia
Logistic Models
Male
Middle Aged
Odds Ratio
Prognosis
Retrospective Studies
Spironolactone / diagnostic use
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
52-01-7/Spironolactone

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


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