| Outcomes of laparoscopic adrenalectomy for hyperaldosteronism. | |
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MedLine Citation:
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PMID: 17685956 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Primary hyperaldosteronism is a frequent cause of resistant hypertension and is amenable to surgical intervention when caused by a unilateral aldosterone-producing adenoma. The aim of this study was to investigate the long-term results of laparoscopic adrenalectomy in the control of hypertension caused by primary hyperaldosteronism. METHODS: A prospective case series of patients undergoing laparoscopic adrenalectomy for hyperaldosteronism was studied. Blood pressure (BP), serum aldosterone levels, plasma renin activity, serum potassium and antihypertensive requirement were measured before and after adrenalectomy. RESULTS: Sixty-two patients with hyperaldosteronism underwent laparoscopic adrenalectomy in the period from December 1995 to August 2005. The median follow up was 59 months. There was a significant decrease in both systolic blood pressure and diastolic blood pressure at final follow up compared with that before operation. Systolic blood pressure decreased from 149 mmHg to 129 mmHg at final follow up (P < 0.0001). Diastolic blood pressure decreased from 89 mmHg to 80 mmHg (P < 0.0001). Antihypertensive requirement was decreased from an average of 2.6 separate medications preoperatively to 1.4 medications at final follow up (P < 0.0001). Serum aldosterone levels were significantly lower (698 (confidence interval 534-862) pg/mL vs 181 (confidence interval 139-225) pg/mL, P < 0.0001). Overall, 34% of patients had cure of hypertension and did not require any antihypertensive agent. A further 51% had improvement in BP control, whereas 5% had no change or had worsening hypertension. Multivariate regression analysis showed that age and gland size were independent factors predicting sustained hypertension after surgery. CONCLUSION: In appropriately selected patients with primary hyperaldosteronism, laparoscopic adrenalectomy is effective in improving long-term BP control. Larger adrenal gland size and older age at time of surgery are predictors of persisting hypertension. |
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Authors:
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Tony C Pang; Chris Bambach; Judith C Monaghan; Stan B Sidhu; Alex Bune; Leigh W Delbridge; Mark S Sywak |
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Publication Detail:
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Type: Clinical Trial; Journal Article |
Journal Detail:
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Title: ANZ journal of surgery Volume: 77 ISSN: 1445-1433 ISO Abbreviation: ANZ J Surg Publication Date: 2007 Sep |
Date Detail:
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Created Date: 2007-08-09 Completed Date: 2007-11-08 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101086634 Medline TA: ANZ J Surg Country: Australia |
Other Details:
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Languages: eng Pagination: 768-73 Citation Subset: IM |
Affiliation:
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Department of Surgery, University of Sydney Endocrine Surgical Unit, Sydney, Australia. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adrenal Cortex Diseases
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complications,
surgery* Adrenal Cortex Neoplasms / complications, surgery* Adrenal Glands / pathology* Adrenalectomy* Adrenocortical Adenoma / complications, surgery* Female Humans Hyperaldosteronism / etiology, pathology, surgery* Hyperplasia Hypertension / etiology Laparoscopy Male Middle Aged Prospective Studies Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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