Laparoscopic Partial Versus Total Adrenalectomy for Aldosterone Producing Adenoma

Ishidoya, Shigeto; Ito, Akihiro; Sakai, Kiyohide; Satoh, Makoto; Chiba, Yutaka; Sato, Fumitoshi; Arai, Yoichi

doi:10.1097/01.ju.0000162045.68387.c3

Cited by 103 publications

(63 citation statements)

References 10 publications

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“…Histological examination of the adrenal glands removed for APA demonstrated a multifocal character in 27% (ref. 32 ). In these cases, only enucleating or partial resection of adrenal gland does not have the expected therapeutic effect.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of adrenalectomy in patients with primary hyperaldosteronism - a single centre experience

Hartmann¹,

Grepl²,

Vidlář³

et al. 2014

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Introduction. Primary hyperaldosteronism is a common cause of secondary hypertension. In patients with proven unilateral overproduction of aldosterone adrenalectomy can cure hyperaldosteronism with high probability and a positive effect on hypertension. The aim of the study was to determine the effects of unilateral adrenalectomy on blood pressure and laboratory parameters. The secondary objective was to identify parameters that would allow the prediction of hypertension cure. Methods. We performed a cross-sectional analysis of the data of patients who underwent unilateral adrenalectomy for primary aldosteronism at the Department of Urology of University Hospital Olomouc in the years 2000-2011. We assesed the preoperative clinical conditions of patients, the results of biochemical and radiological examinations, course of the surgery and post-operative course including laboratory and clinical parameters during the 12 months postoperatively. Results. 62 patients underwent adrenalectomy for primary aldosteronism in this period. Four patients were excluded from the study due to surprising histology (myelolipoma in 2, carcinoma in 2), seven patients had incomplete postoperative data. The statistical analysis therefore included 51 patients, of which 57% were females. CT or MRI was performed in all patients; 63% patients underwent superselective catheterization of adrenal veins (AVS). Adrenalectomy was performed in all cases laparoscopically. Histology most often showed adrenal hyperplasia (59%), adenoma was detected in 37% and adenoma on the basis of micronodular hyperplasia in 4%. Twelve months after surgery the antihypertensive drugs were discontinued in 17/51 (33%) and the number or dose of antihypertensive drugs was reduced in 25/51 (49%). Normokalemia and normalisation of the aldosterone-renin ratio (ARR) was detected in 92% and 84% of the patients. Performing AVS did not statistically significantly influence the rate of blood pressure control or normalization of ARR, which is probably due to small study size. This study demonstrated a better effect of surgery on blood pressure in younger patients. Conclusions. Unilateral adrenalectomy had a positive effect in 82% of the patients operated for primary aldosteronism and lead to either blood pressure normalization or reduction of the antihypertensive medication.

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Section: Discussionmentioning

confidence: 99%

Outcomes of adrenalectomy in patients with primary hyperaldosteronism - a single centre experience

Hartmann¹,

Grepl²,

Vidlář³

et al. 2014

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…Pierwszym wskazaniem, a jednocześnie do chwili obecnej bardzo kontrowersyjnym, do wykonania operacji oszczędzających korę nadnerczy jest pierwotny hiperaldosteronizm -zespół Conna [20][21][22].…”

Section: Szkolenie Podyplomoweunclassified

“…Podobnie, bez względu na wskazania do wykonania operacji nieradykalnej, dla zachowania bezpieczeństwa SZKOLENIE PODYPLOMOWE -jednostronne pheochromocytoma w udokumentowanych przypadkach genetycznego uwarunkowania, -hiperaldosteronizm pierwoty w wyniku gruczolaka jednego nadnercza z prawidłowym drugim nadnerczem, -jednostrony gruczolak nadnercza w Zespole Cushinga, -torbiel rzekoma lub torbiel endotelialna nadnercza [9,10,16,17,18,20,22,[25][26][27].…”

Section: Szkolenie Podyplomoweunclassified

“…classical open methods, -securing or not the central adrenal vein does not affect the final result, -preservation of blood supply to the remaining part of the gland plays an important role [9,17,18,20,25,26,28]. Despite the comparable effectiveness of both methods (classical -open, videoscopic), the laparoscopic operations are more likely to create opportunities to meet these conditions.…”

Section: ) -Efficacy Is Comparable Between Videoscopic Andmentioning

confidence: 99%

“…4). The first recommendation, which has been very controversial, for a sparing operation of the adrenal cortex is primary aldosteronism -Conn's syndrome [20][21][22].…”

Section: Szkolenie Podyplomowementioning

confidence: 99%

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Nieradykalne (oszczędzające) operacje guzów nadnerczy

Otto

Dzwonkowski²

2015

Endokrynologia Polska

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Currently, laparoscopic adrenalectomy is seen as more than just the preferred method, in fact as a routine procedure, always bearing in mind, however, the developed restraints on its usage. The size of the tumour, recurrent disease, and the existing invasive process all remain factors which determine the indications for operation. The situation is similar in cases of qualifying for sparing (non-radical) operations on adrenal glands. The basic challenge in terms of qualification, choice of technique and the range of operation of adrenal lesions remains: obtaining a reliable preoperative diagnosis, the localisation of lesions including their ectopic location, the evaluation of the imaging phenotype, as well as a proper pre-surgical preparation. Maintaining one third of properly vascularised adrenal mass allows one to avoid a substitutive therapy, with the possible necessity of its application in stressful situations. The first partial adrenalectomy has been conducted on a patient with a bilateral pheochromocytoma, in order to retain the glucocorticoid adrenal functions. The recommendations for its administration remain: hereditary pheochromocytoma of at least 2cm diameter, unilateral adenoma of at least 5cm diameter in Cushing's syndrome without any concomitant lesions in the oposite adrenal gland, and unilateral adenoma in Conn's syndrome. It seems that non-radical resection should always be considered for patients at risk of bilateral adrenalectomy in cases of concomitant lesions in both adrenals. StreszczenieObecnie adrenalektomia laparoskopowa traktowana jest już nie tylko jako metoda preferowana, lecz jako postępowanie rutynowe, jednak przy zachowaniu wypracowanych ograniczeń do jej zastosowania. Wielkość guza, zmiany nawrotowe, istniejący proces inwazyjny pozostają czynnikami warunkującymi wskazania do jej wykonania. Podobnie jest w kwalifikacji do operacji oszczędzających (nieradykalnych) na nadnerczach. Podstawową kwestią w kwalifikacji, doborze wyboru techniki i zakresu operacji zmian nadnerczowych pozostaje: pewność przedoperacyjnego rozpoznania, lokalizacja zmian łącznie z ekotopowym ich położeniem, ocena obrazowego fenotypu jak również właściwe przygotowanie przedoperacyjne. Zachowanie 1/3 dobrze unaczynionej masy nadnerczy pozwala na uniknięcie terapii substytucyjnej z możliwą koniecznością jej zastosowania w sytuacjach stresowych. Pierwszą częściową adrenalektomię wykonano u chorego z obustronnym guzem chromochłonnym dla utrzymania czynności glikokortykostroidowej nadnerczy. Wskazaniami do jej wykonania pozostają: guz chromochłonny uwarunkowany dziedzicznie o średnicy 2 cm, jednostronny gruczolak o średnicy ≥ 5 cm w zespole Cushinga bez współistniejących zmian w drugim nadnerczu, jednostronny gruczolak w zespole Conna. Wydaje się, że nieradykalna resekcja powinna być zawsze rozważana u chorych zagrożonych obustronną adrenalektomią w przypadkach współistnienia zmian w obu nadnerczach.

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