Outcomes of Laparoscopic Adrenalectomy for Hyperladosteronism

Pang, Tony; Bambach, C. P.; Monaghan, J. C.; Sidhu, Stan; Bune, Alexandra J.; Delbridge, Leigh; Sywak, Mark

doi:10.1111/j.1445-2197.2007.04225.x

Cited by 67 publications

(58 citation statements)

References 37 publications

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“…In our cohort of patients, 33% were normotensive and in another 49% antihypertensive medication had been reduced 12 months after the surgery. A positive effect on blood pressure was demonstrated in 82% patients, which corresponds to published studies [15][16][17][18][19][20][21] .…”

Section: Discussionsupporting

confidence: 88%

“…Previous studies have shown that independent factors for the persistence of hypertension after adrenalectomy are female sex, advanced age, increased BMI, duration of hypertension of over 6 years, more than 3 types of antihypertensive drugs used preoperatively and maximum size of the adrenal gland 15,16,[18][19][20][21][22] . Zarnegar et al proposed a scoring system predicting the benefit to patients of adrenalectomy combining four independent factors: the number of antihypertensive medications used, BMI, duration of hypertension, female sex 23 .…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionsupporting

confidence: 88%

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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“…For example, surgical cure of hypertension has been associated with the following: young age, 21,22 shorter duration of hypertension (eg, <5-10 years), fewer antihypertensive medications (eg, ≤2), higher preoperative blood pressure, preoperative normal renal function, body mass index ≤25 kg/m 2 , female sex, lack of a family history of hypertension, [23][24][25][26] and no evidence of vascular remodeling. 27 These preoperative characteristics serve to guide the clinician and the patient in discussing realistic expectations of surgical outcomes.…”

Section: Selection Of Patients For Avsmentioning

confidence: 99%

“…Where health resources are limited, some selection policy may also be necessary to pre-empt the view that, if 5% of the hypertensive population has unilateral PA, the surgical approach is simply not feasible. 28,29 Nearly all patients with unilateral PA benefit from the surgical approach as evidenced by improved hypertension control, even if hypertension is not cured, 5,[21][22][23][24][25][26][27] and by longterm regression of left ventricular hypertrophy. 5 Realistically, in most public healthcare systems, priority will be given to (1) young patients, who are the most likely to become normotensive with adrenal surgery and gain the most in life-years off treatment and (2) the patients with resistant hypertension (or antihypertensive drug intolerance), whose absolute risk of cardiovascular complications is the highest.…”

Section: Selection Of Patients For Avsmentioning

confidence: 99%

An Expert Consensus Statement on Use of Adrenal Vein Sampling for the Subtyping of Primary Aldosteronism

et al. 2014

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Abstract-Adrenal venous sampling is recommended by current guidelines to identify surgically curable causes of hyperaldosteronism but remains markedly underused. Key factors contributing to the poor use of adrenal venous sampling include the prevailing perceptions that it is a technically challenging procedure, difficult to interpret, and can be complicated by adrenal vein rupture. In addition, the lack of uniformly accepted standards for the performance of adrenal venous sampling contributes to its limited use. Hence, an international panel of experts working at major referral centers was assembled to provide updated advice on how to perform and interpret adrenal venous sampling. To this end, they were asked to use the PICO (Patient or Problem, Intervention, Control or comparison, Outcome) strategy to gather relevant information from the literature and to rely on their own experience. The level of evidence/recommendation was provided according to American Heart Association gradings whenever possible. A consensus was reached on several key issues, including the selection and preparation of the patients for adrenal venous sampling, the procedure for its optimal performance, and the interpretation of its results for diagnostic purposes even in the most challenging

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“…Several studies showed that BP decreases in the majority of patients but antihypertensive agents are required in a significant proportion of cases in order to achieve a normal BP. Reported rates of BP control vary between 33 and 85% (Table 1), but the definition of normal BP was not uniform in these studies, ranging between 140/90 and 160/100 mmHg (Favia et al 1992, Obara et al 1992, Simon et al 1993, Blumenfeld et al 1994, Weigel et al 1994, Celen et al 1996, Lo et al 1996, Proye et al 1998, Sirén et al 1998, Sapienza & Cavallaro 1999, Shen et al 1999, Brunt et al 2001, Sawka et al 2001, Fukudome et al 2002, Rossi et al 2002, Harris et al 2003, Meria et al 2003, Stowasser et al 2003, Goh et al 2004, Meyer et al 2005, Gockel et al 2007, Pang et al 2007. Table 2 summarizes the criteria used to establish the diagnosis of primary APA in the studies reviewed.…”

Section: Management Of Apamentioning

confidence: 96%

Medical treatment as an alternative to adrenalectomy in patients with aldosterone-producing adenomas

Karagiannis¹,

Τζιόμαλος²,

Kakafika³

et al. 2008

Endocrine Related Cancer

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Primary aldosteronism (PA) and, in particular, its two commonest subtypes (i.e. idiopathic hyperaldosteronism (IHA) and aldosterone-producing adenoma (APA)) have been recognized as the most common cause of secondary hypertension. While 'conservative' medical treatment with aldosterone receptor antagonists is the therapeutic approach of choice in controlling blood pressure in patients with PA due to IHA, the more invasive (laparoscopic) adrenalectomy seems to be the most suitable therapy for patients with APA. In this review, we focus on the medical approach for the management of APA in cases where surgical excision of the adrenal is not possible.

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Outcomes of Laparoscopic Adrenalectomy for Hyperladosteronism

Abstract: 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.

Cited by 67 publications

References 37 publications

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

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

An Expert Consensus Statement on Use of Adrenal Vein Sampling for the Subtyping of Primary Aldosteronism

Medical treatment as an alternative to adrenalectomy in patients with aldosterone-producing adenomas

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