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Hundemer GL. Intraprocedural Cortisol Testing During Adrenal Vein Sampling for Primary Aldosteronism: Weighing the Benefits and Limitations. Am J Hypertens 2024; 37:104-106. [PMID: 37793158 PMCID: PMC10790197 DOI: 10.1093/ajh/hpad095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 10/02/2023] [Indexed: 10/06/2023] Open
Affiliation(s)
- Gregory L Hundemer
- Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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2
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Gao RR, Chilukuri N, Rokhlin P, Shebrain S. Thirty day postoperative outcomes following laparoscopic adrenalectomy for functional adrenal tumors. Surg Endosc 2023; 37:7893-7900. [PMID: 37415017 DOI: 10.1007/s00464-023-10255-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Functional adrenal tumors (FATs) are rare and if left untreated, there is a substantial risk of morbidity and mortality due to uncontrolled excess hormone secretion. The three most common FATs are cortisone-producing tumors (hypercortisolism), aldosterone-producing tumors (hyperaldosteronism), and catecholamines-producing tumors (pheochromocytomas). The study aims to evaluate demographic characteristics and 30-day outcomes after laparoscopic adrenalectomy of FATs. METHODS Patients who underwent laparoscopic adrenalectomy for FATs were selected from the ACS-NSQIP database (2015-2017), and divided into three groups (hyperaldosteronism, hypercortisolism, and pheochromocytoma). Preoperative demographics, medical comorbidities, and 30-day postoperative outcomes among the three groups were analyzed using the chi-squared test, analysis of variance (ANOVA) and Kruskal-Wallis one-way analysis of variance. Multivariable logistic regression was performed to assess the effects independent variables on the likelihood of increased overall morbidity. RESULTS Of a total of 2410 patients who underwent laparoscopic adrenalectomy, 345 (14.3%) patients with FATs were included. Patients in the hypercortisolism group were younger, had higher proportion of females, had higher BMI, had a higher proportion of White ethnicity and had a higher proportion of diabetes. The hyperaldosteronism group had a higher proportion of Black ethnicity and a higher proportion of hypertension (HTN) requiring medication. Thirty day postoperative outcomes showed that the pheochromocytoma group had a higher rate of serious morbidity, overall morbidity, and highest readmission rates. There were three deaths, 1 in the pheochromocytoma and 2 in the hypercortisolism groups. Operative time (in minutes) was longer in the hypercortisolism group. Median length of stay was higher in hypercortisolism (2 days) and pheochromocytoma (1.5 day) groups. CONCLUSION Functional adrenal tumors show distinct variations in patient demographics and postoperative outcomes. It is essential to use this information during the preoperative period to optimize patients prior to intervention and counsel patients about potential postoperative outcomes.
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Affiliation(s)
- Raisa R Gao
- Department of General Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Dr., Kalamazoo, MI, 49007, USA.
| | - Nitin Chilukuri
- Department of General Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Dr., Kalamazoo, MI, 49007, USA
| | - Pnina Rokhlin
- Department of General Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Dr., Kalamazoo, MI, 49007, USA
| | - Saad Shebrain
- Department of General Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Dr., Kalamazoo, MI, 49007, USA
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Mills EG, Palazzo FF, Leen E, Wernig F. Emerging Potential of Microwave Ablation for Primary Aldosteronism Resulting From Unilateral Aldosterone-producing Adenoma. JCEM Case Rep 2023; 1:luad077. [PMID: 37908986 PMCID: PMC10580483 DOI: 10.1210/jcemcr/luad077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Indexed: 11/02/2023]
Abstract
Primary aldosteronism (PA) is the most prevalent form of secondary hypertension and is most commonly caused by an adrenal adenoma or bilateral adrenal hyperplasia. Minimally invasive adrenalectomy is the treatment of choice for unilateral disease. Here, we report the case of a 57-year-old man with previous bladder cancer who was referred for evaluation of resistant hypertension and hypokalemia. Diagnostic workup indicated PA with computed tomography imaging revealing a left adrenal adenoma and adrenal venous sampling lateralizing to the left adrenal. He was therefore referred for a left adrenalectomy using a retroperitoneoscopic approach. However, surgery was complicated by significant perinephritis related to previous bladder cancer immunotherapy and, in view of an identifiable adrenal adenoma, a partial adrenalectomy was performed. Despite histology confirming removal of an adrenal adenoma, he remained hypertensive and hypokalemic with persistent PA. He underwent a computed tomography-guided percutaneous thermal (microwave) ablation of the residual adrenal nodule with immediate biochemical reversal of PA. Six years postprocedure, he remains biochemically and clinically cured from PA. This article presents the details of the case and reviews the literature on long-term outcomes for patients undergoing thermal ablation and adrenalectomy, suggesting that thermal ablation may be a viable alternative for selected patients.
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Affiliation(s)
- Edouard G Mills
- Section of Investigative Medicine and Endocrinology, Imperial College London, London W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Fausto F Palazzo
- Department of Endocrine and Thyroid Surgery, Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Edward Leen
- Imaging Department, Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Florian Wernig
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London W12 0HS, UK
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Hundemer GL, Imsirovic H, Kendzerska T, Vaidya A, Leung AA, Kline GA, Goupil R, Madore F, Agharazii M, Knoll G, Sood MM. Screening for Primary Aldosteronism Among Hypertensive Adults with Obstructive Sleep Apnea: A Retrospective Population-Based Study. Am J Hypertens 2023; 36:363-371. [PMID: 36827468 PMCID: PMC10267649 DOI: 10.1093/ajh/hpad022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/20/2023] [Accepted: 02/22/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Hypertension plus obstructive sleep apnea (OSA) is recommended in some guidelines as an indication to screen for primary aldosteronism (PA), yet prior data has brought the validity of this recommendation into question. Given this context, it remains unknown whether this screening recommendation is being implemented into clinical practice. METHODS We conducted a population-based retrospective cohort study of all adult Ontario (Canada) residents with hypertension plus OSA from 2009 to 2020 with follow-up through 2021 utilizing provincial health administrative data. We measured the proportion of individuals who underwent PA screening via the aldosterone-to-renin ratio by year. We further examined screening rates among patients with hypertension plus OSA by the presence of concurrent hypokalemia and resistant hypertension. Clinical predictors associated with screening were assessed via Cox regression modeling. RESULTS The study cohort included 53,130 adults with both hypertension and OSA, of which only 634 (1.2%) underwent PA screening. Among patients with hypertension, OSA, and hypokalemia, the proportion of eligible patients screened increased to 2.8%. Among patients ≥65 years with hypertension, OSA, and prescription of ≥4 antihypertensive medications, the proportion of eligible patients screened was 1.8%. Older age was associated with a decreased likelihood of screening while hypokalemia and subspecialty care with internal medicine, cardiology, endocrinology, or nephrology were associated with an increased likelihood of screening. No associations with screening were identified with sex, rural residence, cardiovascular disease, diabetes, or respirology subspecialty care. CONCLUSIONS The population-level uptake of the guideline recommendation to screen all patients with hypertension plus OSA for PA is exceedingly low.
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Affiliation(s)
- Gregory L Hundemer
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- ICES (formerly Institute for Clinical Evaluative Sciences), Ottawa, Canada
| | - Haris Imsirovic
- ICES (formerly Institute for Clinical Evaluative Sciences), Ottawa, Canada
| | - Tetyana Kendzerska
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- ICES (formerly Institute for Clinical Evaluative Sciences), Ottawa, Canada
- Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Anand Vaidya
- Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander A Leung
- Division of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gregory A Kline
- Division of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rémi Goupil
- Division of Nephrology, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - François Madore
- Division of Nephrology, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Mohsen Agharazii
- Division of Nephrology, Department of Medicine, CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Greg Knoll
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Manish M Sood
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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Anceschi U, Tufano A, Flammia RS, Mormando M, Fiori C, Zappalà O, De Concilio B, Carrara A, Maria Consiglia F, Tuderti G, Brassetti A, Misuraca L, Bove AM, Mastroianni R, Appetecchia M, Tirone G, Porpiglia F, Celia A, Gallucci M, Simone G. Clinical cure vs a novel trifecta system for evaluating long-term outcomes of minimally-invasive partial or total adrenalectomy for unilateral primary aldosteronism: results of a multicentric series. Cent European J Urol 2023; 75:345-351. [PMID: 36794029 PMCID: PMC9903164 DOI: 10.5173/ceju.2022.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/30/2022] [Accepted: 09/30/2022] [Indexed: 02/17/2023] Open
Abstract
Introduction Several predictive scores to evaluate outcomes of adrenal surgery for unilateral primary aldosteronism (UPA), have been conceived. We compared a novel trifecta that summarizes outcomes of adrenal surgery for UPA with the clinical cure proposed by Vorselaars. Material and methods Between March 2011 and January 2022, a multi-institutional dataset was queried for UPA. Baseline, perioperative and functional data were collected. Clinical and biochemical complete and partial success rates according to Primary Aldosteronism Surgical Outcome (PASO) criteria were assessed for the overall cohort. Clinical cure was defined either as normotension without antihypertensive medications or normotension with lower or equal use of antihypertensive medications. Trifecta was defined as the coexistence of ≥50% antihypertensive therapeutic intensity score (TIS) reduction (ΔTIS), no electrolyte impairment at 3-months and no Clavien-Dindo (2-5) complications. Cox regression analyses were used to identify predictors of long-term clinical and biochemical success. For all analyses, a two-sided p <0.05 was considered significant. Results Baseline, perioperative and functional outcomes were analyzed. Out of 90 patients, at a median follow-up of 42 months (IQR 27-54) a complete and partial clinical success was observed in 60% and 17.7% of cases while a complete and partial biochemical success was achieved in 83.3% and 12.3% of cases, respectively. Overall trifecta and clinical cure rates were 21.1% and 58.9%, respectively. On multivariable Cox regression analysis, trifecta achievement (HR 2.87; 95% CI 1.45-5.58; p = 0.02) was the only independent predictor of complete clinical success at long-term follow-up. Conclusions Despite its complex estimation and more restrictive criteria, trifecta but not clinical cure allows to independently predict composite PASO endpoints on the long run.
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Affiliation(s)
- Umberto Anceschi
- Department of Urology, IRCSS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Antonio Tufano
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Rocco Simone Flammia
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Marilda Mormando
- Oncological Endocrinology Unit, IRCSS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi-Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Orazio Zappalà
- Department of General Surgery, Santa Chiara Regional Hospital, Largo Medaglie d'Oro, Trento, Italy
| | - Bernardino De Concilio
- Department of Urology, ULSS 7 Pedemontana - San Bassiano Hospital, Bassano del Grappa, Italy
| | - Alessandro Carrara
- Department of General Surgery, Santa Maria del Carmine Hospital, Azienda Sanitaria per i Servizi Sanitari, Rovereto, Italy
| | | | - Gabriele Tuderti
- Department of Urology, IRCSS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Aldo Brassetti
- Department of Urology, IRCSS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Leonardo Misuraca
- Department of Urology, IRCSS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Alfredo Maria Bove
- Department of Urology, IRCSS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Riccardo Mastroianni
- Department of Urology, IRCSS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Marialuisa Appetecchia
- Oncological Endocrinology Unit, IRCSS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Giuseppe Tirone
- Department of General Surgery, Santa Chiara Regional Hospital, Largo Medaglie d'Oro, Trento, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi-Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Antonio Celia
- Department of Urology, ULSS 7 Pedemontana - San Bassiano Hospital, Bassano del Grappa, Italy
| | - Michele Gallucci
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCSS 'Regina Elena' National Cancer Institute, Rome, Italy
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6
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Anceschi U, Mormando M, Flammia RS, Fiori C, Zappalà O, De Concilio B, Brassetti A, Carrara A, Ferriero MC, Tuderti G, Misuraca L, Prata F, Tufano A, Bove AM, Mastroianni R, Appetecchia M, Tirone G, Porpiglia F, Celia A, Simone G. The Therapeutic Intensity Score as Predictor of Clinical Outcomes after Total and Partial Adrenalectomy for Unilateral Primary Aldosteronism: Results of a Multicentric Series. J Clin Med 2023; 12:jcm12030997. [PMID: 36769646 PMCID: PMC9917842 DOI: 10.3390/jcm12030997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND To evaluate the ability of therapeutic intensity score (TIS) in predicting the clinical outcomes of partial (PA) and total adrenalectomy (TA) for UPA. METHODS Between 2011 and 2022, a four-center adrenalectomy dataset was queried for "unilateral adrenal mass" and "UPA" (n = 90). Preoperative TIS of each antihypertensive medication were individually calculated and merged to create a single, cumulative variable. Probability of complete clinical, partial, and absent pooled success rates according to TIS were assessed for the overall cohort by Kaplan-Meier. Cox analyses were used to identify predictors of complete clinical and partial/absent success, respectively. For all analyses, a two-sided p < 0.05 was considered significant. RESULTS At a median follow-up of 42 months (IQR 27-54) complete partial, and absent clinical success were observed in 60%, 17.7%, and 22.3%, respectively. On Kaplan-Meier analysis, TIS < 1 predicted higher complete success rates (p < 0.001), while TIS ≥ 1 was predictor of either partial and absent clinical success (p = 0.008). On multivariable analysis, TIS < 1 (HR 0.25; 95% CI 0.11-0.57; p = 0.001) and adenoma size (HR 1.11; 95% CI 1-1.23; p = 0.0049) were independent predictors of complete clinical success, while TIS ≥ 1 (HR 2.84; 95% CI 1.32-6.1; p = 0.007) was the only independent predictor of absent clinical success. CONCLUSIONS TIS score and adenoma size may help to identify patients who are likely to be at risk of persistent hypertension after surgery.
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Affiliation(s)
- Umberto Anceschi
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
- Correspondence: ; Tel.: +39-339-583-6431 or +39-379-175-0925
| | - Marilda Mormando
- IRCCS “Regina Elena” National Cancer Institute, Oncologic Endocrinology Unit, Via Elio Chianesi, 00144 Rome, Italy
| | - Rocco Simone Flammia
- “La Sapienza” University of Rome, Department of Maternal Infant and Urologic Sciences, Policlinico Umberto I, Viale del Policlinico, 00161 Rome, Italy
| | - Cristian Fiori
- AOU San Luigi Gonzaga, Department of Urology, Regione Gonzole, 10043 Orbassano, Italy
| | - Orazio Zappalà
- APSS, Santa Chiara Regional Hospital, Department of General Surgery, Largo Medaglie d’Oro, 38122 Trento, Italy
| | - Bernardino De Concilio
- ULSS 7 Pedemontana, San Bassiano Hospital, Department of Urology, Via dei Lotti, 36061 Bassano del Grappa, Italy
| | - Aldo Brassetti
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Alessandro Carrara
- APSS, Santa Maria del Carmine Hospital, Department of General Surgery, Corso Verona, 38068 Rovereto, Italy
| | - Maria Consiglia Ferriero
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Gabriele Tuderti
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Leonardo Misuraca
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Francesco Prata
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Antonio Tufano
- “La Sapienza” University of Rome, Department of Maternal Infant and Urologic Sciences, Policlinico Umberto I, Viale del Policlinico, 00161 Rome, Italy
| | - Alfredo Maria Bove
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Riccardo Mastroianni
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Marialuisa Appetecchia
- IRCCS “Regina Elena” National Cancer Institute, Oncologic Endocrinology Unit, Via Elio Chianesi, 00144 Rome, Italy
| | - Giuseppe Tirone
- APSS, Santa Chiara Regional Hospital, Department of General Surgery, Largo Medaglie d’Oro, 38122 Trento, Italy
| | - Francesco Porpiglia
- AOU San Luigi Gonzaga, Department of Urology, Regione Gonzole, 10043 Orbassano, Italy
| | - Antonio Celia
- ULSS 7 Pedemontana, San Bassiano Hospital, Department of Urology, Via dei Lotti, 36061 Bassano del Grappa, Italy
| | - Giuseppe Simone
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
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Flammia RS, Anceschi U, Tufano A, Bologna E, Proietti F, Bove AM, Misuraca L, Mastroianni R, Tirone G, Carrara A, Luciani L, Cai T, Leonardo C, Simone G. Minimally Invasive Partial vs. Total Adrenalectomy for the Treatment of Unilateral Primary Aldosteronism: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11051263. [PMID: 35268355 PMCID: PMC8911420 DOI: 10.3390/jcm11051263] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/04/2022] [Accepted: 02/22/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND This systematic review and metanalysis was conducted to assess differences between perioperative and functional outcomes in patients undergoing minimally-invasive partial (mi-PA) and total adrenalectomy (mi-TA) for unilateral primary aldosteronism (uPHA). MATERIAL AND METHODS Multiple scientific databases (PUBMED, Web of Science, and Cochrane Library) were searched up to November 2021 for surgical series comparing mi-PA vs. mi-TA for uPHA according to the PRISMA statement. Primary outcomes of interest were perioperative and functional outcomes. RESULTS Overall, a total of 802 patients from six eligible studies were identified, with mi-PA and mi-TA performed in 40.4% (n = 324) and 59.6% (n = 478) of cases, respectively. No differences were recorded between the two groups according to number of transfusions, EBL and Clavien-Dindo complications ≥2. Similarly, no differences in clinical success, persistence of postoperative hypokalemia and improvement in HTN were reported between mi-PA and mi-TA. CONCLUSIONS In a uPHA setting, mi-PA and mi-TA provide comparable perioperative and functional outcomes despite the use of mi-PA remains limited to patients with small adenoma size, or hereditary/bilateral disease. Due to limited use of standardized reporting criteria in most of current series, the quest for a superiority of mi-PA over mi-TA in the treatment of uPHA still remains open.
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Affiliation(s)
- Rocco Simone Flammia
- Urology Unit, Department of Maternal-Child and Urological Sciences, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (R.S.F.); (A.T.); (E.B.); (F.P.); (A.M.B.); (L.M.); (R.M.); (C.L.)
| | - Umberto Anceschi
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy;
- Correspondence: ; Tel.: +39-33-9583-6431 or +39-379-175-0925
| | - Antonio Tufano
- Urology Unit, Department of Maternal-Child and Urological Sciences, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (R.S.F.); (A.T.); (E.B.); (F.P.); (A.M.B.); (L.M.); (R.M.); (C.L.)
| | - Eugenio Bologna
- Urology Unit, Department of Maternal-Child and Urological Sciences, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (R.S.F.); (A.T.); (E.B.); (F.P.); (A.M.B.); (L.M.); (R.M.); (C.L.)
| | - Flavia Proietti
- Urology Unit, Department of Maternal-Child and Urological Sciences, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (R.S.F.); (A.T.); (E.B.); (F.P.); (A.M.B.); (L.M.); (R.M.); (C.L.)
| | - Alfredo Maria Bove
- Urology Unit, Department of Maternal-Child and Urological Sciences, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (R.S.F.); (A.T.); (E.B.); (F.P.); (A.M.B.); (L.M.); (R.M.); (C.L.)
| | - Leonardo Misuraca
- Urology Unit, Department of Maternal-Child and Urological Sciences, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (R.S.F.); (A.T.); (E.B.); (F.P.); (A.M.B.); (L.M.); (R.M.); (C.L.)
| | - Riccardo Mastroianni
- Urology Unit, Department of Maternal-Child and Urological Sciences, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (R.S.F.); (A.T.); (E.B.); (F.P.); (A.M.B.); (L.M.); (R.M.); (C.L.)
| | - Giuseppe Tirone
- Department of General Surgery, Santa Chiara Regional Hospital, Azienda Sanitaria per i Servizi Sanitari (APSS), Largo Medaglie d’Oro 9, 38122 Trento, Italy;
| | - Alessandro Carrara
- Department of General Surgery, Santa Maria del Carmine Hospital, Azienda Sanitaria per i Servizi Sanitari (APSS), Corso Verona 4, 38068 Rovereto, Italy;
| | - Lorenzo Luciani
- Department of Urology, Santa Chiara Regional Hospital, Azienda Sanitaria per i Servizi Sanitari (APSS), Largo Medaglie d’Oro 9, 38122 Trento, Italy; (L.L.); (T.C.)
| | - Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, Azienda Sanitaria per i Servizi Sanitari (APSS), Largo Medaglie d’Oro 9, 38122 Trento, Italy; (L.L.); (T.C.)
| | - Costantino Leonardo
- Urology Unit, Department of Maternal-Child and Urological Sciences, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (R.S.F.); (A.T.); (E.B.); (F.P.); (A.M.B.); (L.M.); (R.M.); (C.L.)
| | - Giuseppe Simone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy;
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8
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Anceschi U, Mormando M, Fiori C, Zappalà O, De Concilio B, Brassetti A, Carrara A, Ferriero MC, Tuderti G, Misuraca L, Bove AM, Mastroianni R, Chiefari A, Appetecchia M, Tirone G, Porpiglia F, Celia A, Gallucci M, Simone G. Surgical Quality, Antihypertensive Therapy, and Electrolyte Balance: A Novel Trifecta to Assess Long-Term Outcomes of Adrenal Surgery for Unilateral Primary Aldosteronism. J Clin Med 2022; 11:794. [PMID: 35160247 DOI: 10.3390/jcm11030794] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/05/2022] [Accepted: 01/20/2022] [Indexed: 02/04/2023] Open
Abstract
Background: To propose a trifecta that summarizes endpoints and predicts their maintenance after adrenalectomy (n = 90) for unilateral primary aldosteronism (UPA). Methods: Trifecta was defined as coexistence of: ≥50% antihypertensive therapeutic intensity score reduction (∆TIS), no hypokalemia at 3 months, and no Clavien grade 2–5. Logistic regression was used to identify predictors of trifecta. Probability of clinical, biochemical, and simultaneous success according to trifecta were assessed by Kaplan–Meier. Cox regression was used to identify predictors of long-term clinical, biochemical, and simultaneous success. For all analyses, a two-sided p < 0.05 was considered significant. Results: Simultaneous success rate was 50%. On multivariable analysis, TIS was an independent predictor of trifecta achievement (HR 3.28; 95% CI 1.07–10.9; p = 0.03). At Kaplan–Meier, trifecta predicted higher success for all endpoints (each p < 0.03). On multivariable Cox analysis, adenoma size (AS) ≥6 cm and trifecta were independent predictors of biochemical (AS: HR 2.87; 95% CI 1.53–5.36; trifecta: HR 2.1; 95% CI 1.13–3.90; each p < 0.02) and simultaneous success (AS: HR 3.81; 95% CI 1.68–8.65; trifecta: HR 4.29; 95% CI 2.08–8.86; each p < 0.01), while trifecta was an independent predictor of complete clinical success (HR 2.84; 95% CI 1.45–5.58; p < 0.01). Conclusions: Trifecta and AS are independent predictors of either long-term complete clinical, biochemical, or combined success after adrenalectomy for UPA.
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9
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Sirkeci O, Sirkeci EE, Kucukciloglu Y. Severe Hypokalemia and Rhabdomyolysis Caused by Conn Syndrome. Clin Ter 2021; 172:407-409. [PMID: 34625768 DOI: 10.7417/ct.2021.2347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract Hypokalemia is a common electrolyte abnormality. Generally being asymptomatic, muscular fatigue, paresis and arrhythmia can be seen as the severity of hypokalemia increases. Severe rhabdomyolysis and neuromuscular findings can be seen in severe hypokalemia cases. Presence of hypokalemia can be a precursor of secondary hypertension in hypertensive patients, and also should bring hyperaldosteronism into consideration. Mild hypokalemia is usually seen in primary hype-raldosteronism. However, deficient potassium levels are also seen in some cases. We have shared the case of a hypertensive patient, who presented to the emergency department with findings of rhabdomyo-lysis and neuromuscular findings secondary to severe hypokalemia. The potassium level of our patient was 1.3 mmol, and it was one of the lowest potassium levels reported up to today.
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Affiliation(s)
- Ozgur Sirkeci
- Suleyman Demirel University Medicine Faculty, Department of Gastroenterology, Isparta
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10
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Abstract
PURPOSE OF REVIEW Primary aldosteronism (PA) is the most common cause of secondary hypertension and is significantly under-diagnosed. Delays in diagnosis and treatment can lead to cardiovascular morbidity and mortality. The goal of this study is to review the management of PA, with a focus on medical and surgical treatment outcomes. RECENT FINDINGS PA causes cardiovascular dysfunction in excess of degree of hypertension. Adrenalectomy demonstrates a therapeutic advantage over mineralocorticoid antagonist (MRA) therapy, after controlling for degree of hypertension and subtype of PA. Higher rates of atrial fibrillation, heart failure, stroke, and incidence of chronic kidney disease are observed in subjects treated with MRAs than in subjects treated with adrenalectomy. The therapeutic benefit of surgery may reflect definitive resolution of excess aldosterone. Complete mineralocorticoid blockade may achieve similar benefit to adrenalectomy. Adrenalectomy is the most effective treatment for unilateral PA. Biomarkers for MRA therapy might inform optimal medical therapy of bilateral adrenal hyperplasia.
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Affiliation(s)
- Heather Wachtel
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 4 Silverstein Pavilion, Philadelphia, PA, 19104, USA. .,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Douglas L Fraker
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 4 Silverstein Pavilion, Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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11
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Abstract
BACKGROUND The current first-line screening test for primary hyperaldosteronism is the plasma aldosterone:renin ratio; however, renin assays have several disadvantages and the ARR is affected by medications and physiological factors. Angiotensin II is a key biologically active hormone in the renin-angiotensin-aldosterone system. It has been suggested that measurement of equilibrium levels of this peptide, involving an in vitro incubation of serum prior to analysis, may provide a better marker of renin-angiotensin-aldosterone system activity than renin. METHODS An eqAng II LC-MS/MS assay was developed, optimized and validated. Serum samples were incubated at 37°C for 45 min prior to stabilization with cold EDTA solution, solid phase extraction and LC-MS/MS analysis. Stability in whole blood and the effect of cryoactivation were assessed. For comparison to the current screening test, 150 anonymized patients' samples were analysed for eqAng II, renin activity and aldosterone (all by LC-MS/MS). RESULTS The assay had good precision, minimal bias and acceptable recovery. EqAng II did not change significantly when whole blood samples were stored for up to 72 h, and cryoactivation was only observed for pregnant patients. EqAng II was significantly correlated with renin, and the aldosterone:eqAng II ratio had a strong positive correlation with the aldosterone:renin ratio. CONCLUSIONS An LC-MS/MS assay for eqAng II has been developed which shows promise as an alternative screening test for primary hyperaldosteronism. Compared to renin assays, it is quicker, simpler and less likely to be affected by anti-hypertensive medications. Further clinical validation in hypertensive patients would be required prior to implementation.
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Affiliation(s)
- Laura Bernstone
- Department of Clinical Biochemistry, Darlington Memorial Hospital, County Durham and Darlington NHS Foundation Trust, Darlington, UK
| | - Joanne E Adaway
- Department of Clinical Biochemistry, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Brian G Keevil
- Department of Clinical Biochemistry, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
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12
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Abstract
Background Conn’s syndrome is a curable condition if identified properly. It is characterized by autonomous secretion of aldosterone from the adrenal gland cortex. Its morbidity is related to the increased risk of cardiovascular diseases. Case presentation We report the case of a 48-year-old man of African descent presenting with generalized tonic-clonic seizure and coma secondary to hypertensive encephalopathy. A biochemical evaluation revealed a very high aldosterone level and an undetectable renin level, both are compatible with primary aldosteronism. The presentation of the following confirms the diagnosis of primary aldosteronism: spontaneous hypokalemia, an undetectable renin level, and a high aldosterone level. Abdominal computed tomography revealed a left adrenal adenoma. Adrenal venous sampling confirmed lateralization of aldosterone excretion from the left adrenal gland. Our patient underwent left laparoscopic adrenalectomy that confirmed a left functional adrenal adenoma. After 12 months of follow up, his hypertension was controlled on only one antihypertensive drug which was down from four drugs preoperatively. Conclusion Conn’s syndrome, in this case, was complicated by coma secondary to seizure. Adrenalectomy normalized the hypokalemia and improved resistant hypertension. Potassium supplementation and several antihypertensives were discontinued as our patient became normokalemic and normotensive on one antihypertensive agent.
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Affiliation(s)
- Eiman Alseddeeqi
- Division of Endocrinology, Sheikh Khalifa Medical City, P.O. Box 51900, Abu Dhabi, United Arab Emirates.
| | - Ajda Altinoz
- Division of General Surgery, Tawam Hospital, Al Ain, Abu Dhabi, United Arab Emirates
| | - Najla Ben Ghashir
- Division of Pathology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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13
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Abstract
Primary hyperaldosteronism, also known as Conn's syndrome, is the most common adrenocortical disease in cats. As in humans, this disease is underdiagnosed in cats. Cats presenting with systemic arterial hypertension, hypokalemia, or both quite often are only treated symptomatically without further investigations. This practice may potentially exclude a significant number of cats from receiving appropriate treatment. It is therefore important for general practitioners to be aware of the disease. This article describes the (patho)physiology, clinical presentation, diagnostic approach, and treatment options of for feline primary hyperaldosteronism.
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Affiliation(s)
- Hans S Kooistra
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, Utrecht 3508 TD, The Netherlands.
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14
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Abstract
Primary aldosteronism (PA) is a common cause of secondary hypertension caused by excessive and inappropriate secretion of the hormone aldosterone from one or both adrenal glands. The prevalence of PA ranges from 10% in the general hypertensive population to 20% in resistant hypertension, yet only a small fraction of patients is diagnosed. Disease and symptom recognition, screening in indicated populations, multidisciplinary communication, and appropriate imaging and biochemical workup can identify patients who might benefit from effective and targeted treatment modalities. Effective treatments available include both surgical and medical approaches, usually dependent on the subtype of PA present. Our collective understanding of the pathophysiology of PA is expanded by recent developments in molecular biology and genetics, including understanding the specific somatic and germline mutations involved in pathogenesis. We review the pathophysiology, diagnostic workup, and treatment considerations for this disease process.
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Affiliation(s)
- Sean M Wrenn
- Department of General Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of General Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anand Vaidya
- Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carrie C Lubitz
- Department of General Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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15
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Abstract
PURPOSE OF REVIEW Primary aldosteronism (PA) is a common form of hypertension characterized by autonomous aldosterone secretion from one or both adrenal glands. The purpose of this review is to synthesize recent research findings regarding cardiovascular disease risk in PA both pre- and post-targeted therapy. RECENT FINDINGS Previously considered a rare disease, recent prevalence studies demonstrate that PA is actually a very common, yet vastly under-diagnosed, etiology of hypertension. Prior to targeted therapy, PA is associated with substantially higher rates of cardiovascular disease compared with essential hypertension. Surgical adrenalectomy is highly effective in curing or improving hypertension as well as mitigating cardiovascular disease risk in patients with unilateral PA. For the remainder of PA patients, MR antagonists are recommended; however, several recent studies have brought into question their effectiveness in improving cardiovascular outcomes. PA is a common cause of hypertension that leads to disproportionately high rates of cardiovascular disease. Future studies are needed to enhance the clinical approach to both identification and treatment of patients with PA to optimize long-term cardiovascular outcomes.
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Affiliation(s)
- Gregory L Hundemer
- Division of Nephrology, Ottawa Hospital Research Institute, University of Ottawa, 1967 Riverside Drive, Ottawa, ON, K1H 7W9, Canada.
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16
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Unger N. [Adrenal incidentaloma : Diagnostic and therapeutic concept from an endocrinological perspective]. Chirurg 2019; 90:3-8. [PMID: 30353360 DOI: 10.1007/s00104-018-0739-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
An adrenal incidentaloma is an adrenal mass detected on imaging that was not performed for suspected adrenal disease. The prevalence is approximately 3% and increases up to 10% in older people. The risk of malignancy and a hormone excess have to be evaluated. Approximately 15% of incidentalomas harbor an overproduction of hormones, in particular primary aldosteronism (Conn's syndrome), hypercortisolism (Cushing's syndrome) and pheochromocytoma. Primary aldosteronism is the main cause of endocrine hypertension. It is characterized by an overproduction of aldosterone usually due to a unilateral adenoma or an idiopathic, often bilateral hyperplasia. The aldosterone to renin ratio is an established screening parameter for the diagnosis. If the ratio is elevated a confirmatory test, e. g. saline infusion test, should follow. Usually an adrenal venous catheter has to be used to discriminate between unilateral and bilateral aldosterone overproduction. In the case of unilateral overproduction an adrenalectomy is recommended, otherwise treatment is carried out with an aldosterone antagonist. For the diagnosis of an adrenal Cushing's syndrome a dexamethasone suppression test and a suppressed or in the lower limit of normal ACTH is required. The rare pheochromocytoma is a catecholamine-producing tumor. The diagnosis is carried out by determination of metanephrines in plasma or in 24 h urine samples. Unilateral adrenal tumors leading to clinically significant hormone excess or tumors with suspicion of malignancy should be surgically removed. A minimally invasive adrenalectomy is normally the method of choice in patients with a unilateral adrenal tumor <6 cm and without local tumor invasion. In unilateral, clearly benign, non-functioning, small adrenal tumors (<4 cm) surgery is not required.
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17
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Wierdak M, Sokołowski G, Natkaniec M, Morawiec-Sławek K, Małczak P, Major P, Hubalewska-Dydejczyk A, Budzyński A, Pędziwiatr M. Short- and long-term results of laparoscopic adrenalectomy for Conn's syndrome. Wideochir Inne Tech Maloinwazyjne 2018; 13:292-8. [PMID: 30302141 DOI: 10.5114/wiitm.2018.74833] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/02/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction The primary treatment of Conn’s syndrome (CS) is laparoscopic adrenalectomy and aims to normalize arterial blood pressure and biochemical parameters. Aim To analyse short- and long-term results of laparoscopic adrenalectomy for Conn’s syndrome (CS). Material and methods The analysis included 44 consecutive patients, who underwent laparoscopic adrenalectomy between 2004 and 2015 for CS. We analysed short- and long-terms results of operations. All patients were followed up 6 and 24 months after surgery to determine changes in the biochemical parameters, and clinical regression of arterial hypertension. We also evaluated the aldosteronoma resolution score (ARS) in predicting the resolution of hypertension. Results No conversions were needed. Complications occurred in 5 (11.4%) patients. Preoperative hypokalaemia and hypernatraemia were present in 83.4% and 15.8% of patients, respectively. After surgery, both hypokalaemia and hypernatraemia resolved in all patients. At the follow-up 6 months after the surgery, only 11.3% of patients had complete remission (CR) of hypertension. In 43.2% of cases we observed partial remission (PR). After 24 months CR was found in 13.6% of patients, 45.5% patients fulfilled criteria for PR, and 29.5% of patients changed the group of remission comparison to the first follow-up visit. Only 50% of patients with an ARS of 4 or 5 points achieved CR 6 months after surgery. Conclusions Laparoscopic adrenalectomy is a safe method of treatment for CS. Although it effectively eliminates electrolyte imbalance, it does not allow for the CR of hypertension in the majority of patients, especially in the elderly group. We did not find ARS to be an effective tool in predicting postoperative resolution of hypertension.
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18
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Furlanis G, Bernardi S, Cavressi M, Zandonà L, Carretta R, Fabris B, Bardelli M. A case report of hyponatremia after surgery for Conn's adenoma. J Renin Angiotensin Aldosterone Syst 2017; 18:1470320317740240. [PMID: 29141492 PMCID: PMC5843937 DOI: 10.1177/1470320317740240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Primary aldosteronism (PA), also known as Conn's syndrome, is a frequent cause of secondary hypertension. If PA is due to a documented unilateral adrenal adenoma, adrenalectomy is the treatment of choice. Endocrine Society guidelines suggest monitoring potassium after adrenalectomy, while there is no mention of sodium disorders after surgery. Here we report the case of a patient with Conn's syndrome who developed hyponatremia after surgery. This was an unexpected event in the course of the treatment, which sheds light on the fact that low levels of aldosterone strongly influence sodium concentration, and advises clinicians to monitor sodium after adrenalectomy.
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Affiliation(s)
- Giulia Furlanis
- 1 Department of Medical Sciences, University of Trieste, Italy.,2 ASUITS - Azienda Sanitaria Universitaria Integrata di Trieste, Cattinara Teaching Hospital, Italy
| | - Stella Bernardi
- 1 Department of Medical Sciences, University of Trieste, Italy.,2 ASUITS - Azienda Sanitaria Universitaria Integrata di Trieste, Cattinara Teaching Hospital, Italy
| | - Monica Cavressi
- 1 Department of Medical Sciences, University of Trieste, Italy.,2 ASUITS - Azienda Sanitaria Universitaria Integrata di Trieste, Cattinara Teaching Hospital, Italy
| | - Lorenzo Zandonà
- 1 Department of Medical Sciences, University of Trieste, Italy.,2 ASUITS - Azienda Sanitaria Universitaria Integrata di Trieste, Cattinara Teaching Hospital, Italy
| | - Renzo Carretta
- 1 Department of Medical Sciences, University of Trieste, Italy.,2 ASUITS - Azienda Sanitaria Universitaria Integrata di Trieste, Cattinara Teaching Hospital, Italy
| | - Bruno Fabris
- 1 Department of Medical Sciences, University of Trieste, Italy.,2 ASUITS - Azienda Sanitaria Universitaria Integrata di Trieste, Cattinara Teaching Hospital, Italy
| | - Moreno Bardelli
- 1 Department of Medical Sciences, University of Trieste, Italy.,2 ASUITS - Azienda Sanitaria Universitaria Integrata di Trieste, Cattinara Teaching Hospital, Italy
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19
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Deipolyi AR, Bailin A, Wicky S, Alansari S, Oklu R. Adrenal Vein Sampling for Conn's Syndrome: Diagnosis and Clinical Outcomes. Diagnostics (Basel) 2015; 5:254-71. [PMID: 26854152 DOI: 10.3390/diagnostics5020254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/06/2015] [Accepted: 06/03/2015] [Indexed: 11/30/2022] Open
Abstract
Adrenal vein sampling (AVS) is the gold standard test to determine unilateral causes of primary aldosteronism (PA). We have retrospectively characterized our experience with AVS including concordance of AVS results and imaging, and describe the approach for the PA patient in whom bilateral AVS is unsuccessful. We reviewed the medical records of 85 patients with PA and compared patients who were treated medically and surgically on pre-procedure presentation and post-treatment outcomes, and evaluated how technically unsuccessful AVS results were used in further patient management. Out of the 92 AVS performed in 85 patients, AVS was technically successful bilaterally in 58 (63%) of cases. Either unsuccessful AVS prompted a repeat AVS, or results from the contralateral side and from CT imaging were used to guide further therapy. Patients who were managed surgically with adrenalectomy had higher initial blood pressure and lower potassium levels compared with patients who were managed medically. Adrenalectomy results in significantly decreased blood pressure and normalization of potassium levels. AVS can identify surgically curable causes of PA, but can be technically challenging. When one adrenal vein fails to be cannulated, results from the contralateral vein can be useful in conjunction with imaging and clinical findings to suggest further management.
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20
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Abstract
There is a growing body of evidence supporting a bidirectional relationship between parathyroid hormone (PTH) and aldosterone (Aldo). We report a case of secondary hypertension due to concomitant Aldo-producing adenoma (APA) and parathyroid adenoma (PA) requiring both unilateral adrenalectomy and parathyroidectomy.
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Affiliation(s)
- Katrina Chau
- Division of Nephrology, University of British Columbia, Vancouver, BC, Canada
| | - Daniel Holmes
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Adrienne Melck
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Clifford Chan-Yan
- Division of Nephrology, University of British Columbia, Vancouver, BC, Canada;
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21
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Yetişir F, Salman AE, Özkardeş A, Tokaç M, Çiftçi B, Kılıç M. Cortex sparing laparoscopic adrenalectomy in a patient with Conn's syndrome. Turk J Surg 2013; 29:38-41. [PMID: 25931842 PMCID: PMC4379767 DOI: 10.5152/ucd.2013.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 11/10/2011] [Indexed: 11/22/2022]
Abstract
Conn's syndrome, an aldosterone producing adenoma, is a surgically curable cause of primary aldosteronism, classically treated by unilateral adrenalectomy. With the advent of laparoscopic surgery in the recent decade, laparoscopic adrenalectomy is currently accepted as the gold standard of treatment for Conn's syndrome. Cortical sparing adrenalectomy is especially an ideal operation for patients with bilateral pheochromocytoma. This case report describes a successful laparoscopic adrenal cortex sparing surgery on the left side and anesthetic approach in a patient with Conn's syndrome, who had a history of previous right surrenalectomy. Laparoscopic surgery without dividing the central adrenal vein can also be performed successfully in patients with Conn's syndrome.
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Affiliation(s)
- Fahri Yetişir
- Clinic of General Surgery, Ministry of Health Ankara Atatürk Training Hospital, Ankara, Turkey
| | - A. Ebru Salman
- Clinic of Anesthesiology, Ministry of Health Ankara Atatürk Training Hospital, Ankara, Turkey
| | - Alper Özkardeş
- Clinic of General Surgery, Ministry of Health Ankara Atatürk Training Hospital, Ankara, Turkey
| | - Mehmet Tokaç
- Clinic of General Surgery, Ministry of Health Ankara Atatürk Training Hospital, Ankara, Turkey
| | - Burak Çiftçi
- Clinic of General Surgery, Ministry of Health Ankara Atatürk Training Hospital, Ankara, Turkey
| | - Mehmet Kılıç
- Clinic of General Surgery, Ministry of Health Ankara Atatürk Training Hospital, Ankara, Turkey
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22
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Nagarajan R, Kuberan K, Senthil Kumar MS, Chandrasekaran M. Is hyperaldosteronism a pathognomonic feature of conn's syndrome? Indian J Surg 2010; 72:146-8. [PMID: 23133229 DOI: 10.1007/s12262-010-0025-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2008] [Accepted: 11/16/2008] [Indexed: 11/25/2022] Open
Abstract
A 10-year-old female child presented with resistant hypertension and hypokalaemia. There was no muscle weakness or periodic paralysis. The ratio of plasma aldosterone concentration to plasma renin activity was increased. MRI of the abdomen showed the right adrenal mass. The child underwent open right adrenalectomy. she had natriuresis in the postoperative period. She was normotensive without antihypertensive drugs at discharge and 2 months after surgery.
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Affiliation(s)
- R Nagarajan
- Department of Endocrine Surgery, Madras Medical College, Chennai, India
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23
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Schirpenbach C, Segmiller F, Diederich S, Hahner S, Lorenz R, Rump LC, Seufert J, Quinkler M, Bidlingmaier M, Beuschlein F, Endres S, Reincke M. The diagnosis and treatment of primary hyperaldosteronism in Germany: results on 555 patients from the German Conn Registry. Dtsch Arztebl Int 2009; 106:305-11. [PMID: 19547646 DOI: 10.3238/arztebl.2009.0305] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Accepted: 12/17/2008] [Indexed: 11/27/2022]
Abstract
BACKGROUND Primary hyperaldosteronism (Conn's syndrome) is being diagnosed increasingly often. As many as 12% of patients with hypertension have the characteristic laboratory constellation of Conn's syndrome. Its diagnosis and treatment have not been standardized. METHODS The authors retrospectively analyzed data of 555 patients (327 men and 228 women, aged 55 +/- 13 years) who were treated for primary hyperaldosteronism in 5 different centers from 1990 to 2006. The objective was to determine center-specific features of diagnosis and treatment. RESULTS 353 (63%) of the patients had the hypokalemic variant of primary hyperaldosteronism; 202 never had documented hypokalemia. The centers differed markedly with respect to the patients' clinical presentation, diagnostic testing of endocrine function, and diagnostic imaging techniques, including adrenal venous sampling. The adrenalectomy rate ranged from 15% to 46%. CONCLUSIONS The registry data reveal an unexpected heterogeneity in the diagnostic evaluation and treatment of primary hyperaldosteronism. National or international guidelines are needed so that these can be standardized.
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Affiliation(s)
- Caroline Schirpenbach
- Medizinische Klinik Innenstadt, Klinikum der Ludwig-Maximilians-Universität München, Germany
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