Is Adrenal Venous Sampling Mandatory Before Surgical Decision in Case of Primary Hyperaldosteronism?

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2014 Feb 1

PMID 24481990

Citations 9

Authors

Augustin Pirvu

Nora Naem

Jean Philippe Baguet

Frederic Thony

Olivier Chabre

Philippe Chaffanjon

Affiliations

Soon will be listed here.

Abstract

Background: Primary hyperaldosteronism (PHA) is a cause of secondary arterial hypertension potentially curable by laparoscopic unilateral adrenalectomy. We describe the follow-up of these patients according to their medical or surgical treatment.

Methods: We report a retrospective single-center study of 91 patients with PHA from 1998 to 2012. Treatment was guided by computed tomography (CT) scans. Preoperative adrenal vein sampling (AVS) was performed when the CT scan did not show single solitary unilateral nodules on the adrenal glands. During the follow-up, we considered hypertension to be cured in patients with normal blood pressure without antihypertensive medication (AM), and improvement was defined by a decrease in AM.

Results: A total of 28 patients received only AM. Of the 62 patients who underwent a unilateral adrenalectomy, 46 (74 %) had an adrenal adenoma, 14 (22 %) a hyperplasia, and the adrenal gland was normal in two cases. Hypertension was cured in 24 cases (38 %), and 28 patients (45 %) showed improvement with a reduction in AM. Predictive factors for a cure were gender, age, number of preoperative AMs, preoperative arterial systolic blood pressure, and plasma renin activity. All patients who presented with hypokalemia were cured postoperatively. We performed 38 AVS and nine of these patients were operated on based on the AVS findings, with an improvement of 100 % of arterial blood pressure after surgery.

Conclusion: Laparoscopic unilateral adrenalectomy for PHA cured or improved hypertension in 84 % of patients. Preoperative AVS is mandatory for surgical decision making if the CT scan shows bilateral or no lesions associated with PHA.

Citing Articles

Prognosis of adrenalectomy guided by computed tomography versus adrenal vein sampling in patients with primary aldosteronism: A systematic review and meta-analysis.

Yan Y, Sun H, Qi Y J Clin Hypertens (Greenwich). 2022; 24(2):106-115.

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A Clinical-Radiomic Nomogram Based on Unenhanced Computed Tomography for Predicting the Risk of Aldosterone-Producing Adenoma.

He K, Zhang Z, Wang Z, Wang Y, Wang Y, Zhang H Front Oncol. 2021; 11:634879.

PMID: 34307119 PMC: 8300014. DOI: 10.3389/fonc.2021.634879.

Experience in identifying the variant adrenal venous anatomy during modified retroperitoneoscopic adrenalectomy.

Hu D, Zhu D, Zhang Y, Wang X J Minim Access Surg. 2021; 17(2):175-179.

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Surgical therapy of adrenal tumors: guidelines from the German Association of Endocrine Surgeons (CAEK).

Lorenz K, Langer P, Niederle B, Alesina P, Holzer K, Nies C Langenbecks Arch Surg. 2019; 404(4):385-401.

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A case report of hyponatremia after surgery for Conn's adenoma.

Furlanis G, Bernardi S, Cavressi M, Zandona L, Carretta R, Fabris B J Renin Angiotensin Aldosterone Syst. 2017; 18(4):1470320317740240.

PMID: 29141492 PMC: 5843937. DOI: 10.1177/1470320317740240.

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