American Association of Endocrine SurgeonUnilateral adrenal hyperplasia: A novel cause of surgically correctable primary hyperaldosteronism
Section snippets
Material and methods
The present study focused on patients who underwent adrenalectomy after successful unequivocal lateralization of the hypersecretion by AVS. They were selected from 111 patients surgically treated because of primary hyperaldosteronism at the Endocrine Surgery Unit, University of Padua, Italy, between 1990 and 2010.
Inpatient and outpatient medical records were retrospectively reviewed, and hormonal and biochemical evaluations (including aldosterone/renin ratio [ARR] and serum potassium levels),
Results
The results are summarized in Table I, Table II. The study included 35 patients (15 women and 20 men; median age 47 years; range, 34 to 72); arterial hypertension was present in all cases; hypokalemia was present in 33 patients (94.3%).
Of the patients, 4 underwent laparotomic and 31 underwent laparoscopic adrenalectomies performed by the transperitoneal approach in flank position; no major surgery-related morbidity occurred. Pathology revealed 9 APAs (25.7%) (according to the finding of a
Discussion
Primary hyperaldosteronism has been regarded as a very rare (less than 1%) cause of arterial hypertension for several decades, but it is now recognized as the most common cause of endocrine hypertension.1, 2, 3, 4
Primary hyperaldosteronism may be caused by surgically curable cases (APA, two thirds of cases) and nonsurgically curable variants (IAH, one third of cases),3 which may be distinguished by lateralization studies.8, 10 AVS is actually considered the most effective technique to
References (21)
- et al.
A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients
J Am Coll Cardiol
(2006) - et al.
Clinical outcome after laparoscopic adrenalectomy for primary hyperaldosteronism: the role of pathology
Surgery
(2010) - et al.
Role for adrenal venous sampling in primary aldosteronism
Surgery
(2004) - et al.
Clinical outcomes of laparoscopic adrenalectomy for lateralizing nodular hyperplasia
Surgery
(2005) - et al.
Lessons learned from 274 laparoscopic adrenalectomies
Ann Chir
(2002) - et al.
Unique cases of unilateral hyperaldosteronemia due to multiple adrenocortical micronodules, which can only be detected by selective adrenal venous sampling
Metabolism
(2002) Conn's syndrome due to adrenal hyperplasia with hypertrophy of zona glomerulosa, relieved by unilateral adrenalectomy
Am J Med
(1965)- et al.
Laparoscopic partial versus total adrenalectomy for aldosterone producing adenoma
J Urol
(2005) Prevalence and diagnosis of primary aldosteronism
Curr Hypertens Rep
(2010)- et al.
Systematic review: diagnostic procedures to differentiate unilateral from bilateral adrenal abnormality in primary aldosteronism
Ann Intern Med
(2009)
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