Top

Published in:

01-10-2019 | Adrenalectomy | Original Scientific Report

Primary Aldosteronism: Does Underlying Pathology Impact Clinical Presentation and Outcomes Following Unilateral Adrenalectomy?

Authors: Omair A. Shariq, Kabir Mehta, Geoffrey B. Thompson, Melanie L. Lyden, David R. Farley, Irina Bancos, Benzon M. Dy, William F. Young Jr., Travis J. McKenzie

Published in: World Journal of Surgery | Issue 10/2019

Abstract

Introduction

Patients undergoing unilateral adrenalectomy for primary aldosteronism (PA) may have a solitary adenoma, unilateral hyperplasia, or multiple adenomas on final pathology. This study investigated whether the underlying pathological diagnosis was associated with differences in clinical presentation and postoperative outcomes.

Methods

A retrospective cohort study of patients undergoing unilateral adrenalectomy for PA from 2004 to 2015 at our institution was performed. Baseline clinical and laboratory parameters, as well as postoperative biochemical and hypertension cure rates, were compared across the three aforementioned pathological groups.

Results

Of 206 patients who met criteria for inclusion, 152 (73.8%) had a single adenoma, 33 (16%) had unilateral hyperplasia, and 21 (10.2%) had multiple unilateral adenomas. Patients with unilateral hyperplasia were more likely to be male (81.2% vs 57.9%, P = .03), undergo left-sided adrenalectomy (78.8% vs 47.4%, P < .01), and had a lower median adrenal venous sampling lateralization index (9.8 vs 19.8, P = .04) compared to those with solitary, but not multiple unilateral adenomas. No differences were seen in age, duration of hypertension, preoperative plasma aldosterone levels, plasma renin activities, 24-h urinary aldosterone excretion, serum potassium concentrations, and the number of preoperative antihypertensive medications across all three pathological groups. All patients achieved biochemical cure following adrenalectomy, and no significant differences in the rates of hypertension cure or improvement were observed in comparisons across pathological subtype.

Conclusions

Clinical presentation and postoperative outcomes are similar regardless of underlying pathology in patients with PA. Because one in four patients may harbor unilateral hyperplasia or multiple adenomas, total unilateral adrenalectomy should be performed as the operation of choice over adrenal-sparing approaches.

Young WF (2007) Primary aldosteronism: renaissance of a syndrome. Clin Endocrinol (Oxf) 66(5):607–618CrossRef

Funder JW, Carey RM, Mantero F et al (2016) The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 101(5):1889–1916CrossRef

Milliez P, Girerd X, Plouin PF et al (2005) Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol 45(8):1243–1248CrossRef

Rossi GP, Bernini G, Desideri G et al (2006) Renal damage in primary aldosteronism: results of the PAPY study. Hypertension 48(2):232–238CrossRef

Rossi GP, Sechi LA, Giacchetti G et al (2008) Primary aldosteronism: cardiovascular, renal and metabolic implications. Trends Endocrinol Metab 19(3):88–90CrossRef

Quillo AR, Grant CS, Thompson GB et al (2011) Primary aldosteronism: results of adrenalectomy for nonsingle adenoma. J Am Coll Surg 213(1):106–112CrossRef

Trésallet C, Salepçioglu H, Godiris-Petit G et al (2010) Clinical outcome after laparoscopic adrenalectomy for primary hyperaldosteronism: the role of pathology. Surgery 148(1):129–134CrossRef

Novitsky YW, Kercher KW, Rosen MJ et al (2005) Clinical outcomes of laparoscopic adrenalectomy for lateralizing nodular hyperplasia. Surgery 138(6):1009–1017CrossRef

Morioka M, Kobayashi T, Sone A et al (2008) Primary aldosteronism due to unilateral adrenal hyperplasia. Report of two cases and review of the literature. Endocr J 47(4):443–449CrossRef

10.

Iacobone M, Citton M, Viel G et al (2012) Unilateral adrenal hyperplasia: a novel cause of surgically correctable primary hyperaldosteronism. Surgery 152(6):1248–1255CrossRef

11.

Leung A, Sasano H, Nishikwa T et al (2013) Multiple unilateral adrenal adenomas in a patient with primary hyperaldosteronism. Endocr Pract 14(1):76–79CrossRef

12.

Hashimoto N, Kawamura Y, Nakamura T et al (2011) A case of primary aldosteronism caused by multiple adrenocortical macronodules. Intern Med 50(6):585–590CrossRef

13.

Stowasser M, Gordon RD (2013) The renaissance of primary aldosteronism: What has it taught us? Hear Lung Circ 22(6):412–420CrossRef

14.

Walz MK, Gwosdz R, Levin SL et al (2008) Retroperitoneoscopic adrenalectomy in Conn’s syndrome caused by adrenal adenomas or nodular hyperplasia. World J Surg 32(5):847–853. https://doi.org/10.1007/s00268-008-9513-0 CrossRefPubMed

15.

Sigurjonsdottir HA, Gronowitz M, Andersson O et al (2012) Unilateral adrenal hyperplasia is a usual cause of primary hyperaldosteronism. Results from a Swedish screening study. BMC Endocr Disord 12:17CrossRef

16.

Weisbrod AB, Webb RC, Mathur A et al (2013) Adrenal histologic findings show no difference in clinical presentation and outcome in primary hyperaldosteronism. Ann Surg Oncol 20(3):753–758CrossRef

17.

Obara T, Ito Y, Okamoto T et al (1992) Risk factors associated with postoperative persistent hypertension in patients with primary aldosteronism. Surgery 112(6):987–993PubMed

18.

Ito Y, Fujimoto Y, Obara T, Kodama T (1990) Clinical significance of associated nodular lesions of the adrenal in patients with aldosteronoma. World J Surg 14(3):330–334. https://doi.org/10.1007/BF01658518 CrossRefPubMed

19.

Hennings J, Andreasson S, Botling J et al (2010) Long-term effects of surgical correction of adrenal hyperplasia and adenoma causing primary aldosteronism. Langenbeck’s Arch Surg 395(2):133–137CrossRef

20.

Gioco F, Seccia TM, Gomez-Sanchez EP et al (2015) Adrenal histopathology in primary aldosteronism: Is it time for a change? Hypertension 66(4):724–730CrossRef

21.

Mete O, Duan K (2018) The many faces of primary aldosteronism and cushing syndrome: a reflection of adrenocortical tumor heterogeneity. Front Med 5:54CrossRef

22.

Young WF, Stanson AW (2009) What are the keys to successful adrenal venous sampling (AVS) in patients with primary aldosteronism? Clin Endocrinol (Oxf) 70(1):14–17CrossRef

23.

Zhang Z, Meng H, Hou Z et al (2013) Fetal adrenal gland in the second half of gestation: morphometrical assessment with 3.0T post-mortem MRI. PLoS ONE 8(10):e75511CrossRef

24.

Lam KY, Chan ACL, Lo CY (2001) Morphological analysis of adrenal glands: a prospective analysis. Endocr Pathol 12(1):33–38CrossRef

25.

Katayama Y, Takata N, Tamura T et al (2005) A case of primary aldosteronism due to unilateral adrenal hyperplasia. Hypertens Res 28(4):379–384CrossRef

26.

Proye CAG, Mulliez EAR, Carnaille BML et al (1998) Essential hypertension: first reason for persistent hypertension after unilateral adrenalectomy for primary aldosteronism? Surgery 124(6):1128–1133CrossRef

27.

Walz MK, Peitgen K, Saller B et al (1998) Subtotal adrenalectomy by the posterior retroperitoneoscopic approach. World J Surg 22(6):621–627. https://doi.org/10.1007/s002689900444 CrossRefPubMed

28.

Ishidoya S, Ito A, Sakai K et al (2005) Laparoscopic partial versus total adrenalectomy for aldosterone producing adenoma. J Urol 174(1):40–43CrossRef

29.

Nanba AT, Nanba K, Byrd JB et al (2017) Discordance between imaging and immunohistochemistry in unilateral primary aldosteronism. Clin Endocrinol (Oxf) 87(6):665–672CrossRef

30.

Volpe C, Hamberger B, Höög A et al (2015) Primary aldosteronism: functional histopathology and long-term follow-up after unilateral adrenalectomy. Clin Endocrinol (Oxf) 82(5):639–647CrossRef

31.

Swearingen AJ, Kahramangil B, Monteiro R et al (2018) Analysis of postoperative biochemical values and clinical outcomes after adrenalectomy for primary aldosteronism. Surgery 163(4):807–810CrossRef

32.

Kline GA, Darras P, Leung AA et al (2018) Surprisingly low aldosterone levels in peripheral veins following intravenous sedation during adrenal vein sampling. J Hypertens 37(3):596–602CrossRef

Title: Primary Aldosteronism: Does Underlying Pathology Impact Clinical Presentation and Outcomes Following Unilateral Adrenalectomy?
Authors: Omair A. Shariq
Kabir Mehta
Geoffrey B. Thompson
Melanie L. Lyden
David R. Farley
Irina Bancos
Benzon M. Dy
William F. Young Jr.
Travis J. McKenzie
Publication date: 01-10-2019
Publisher: Springer International Publishing
Keywords: Adrenalectomy
Pathology
Hypertension
Adrenalectomy
Hypertension
Published in: World Journal of Surgery / Issue 10/2019
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-019-05059-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Primary Aldosteronism: Does Underlying Pathology Impact Clinical Presentation and Outcomes Following Unilateral Adrenalectomy?

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 10/2019

Antimicrobial Prophylaxis Redosing Reduces Surgical Site Infection Risk in Prolonged Duration Surgery Irrespective of Its Timing

Treatment and Outcome of 341 Papillary Breast Lesions

Author’s Reply: Significance of Intramural Metastasis in Patients with Esophageal Squamous Cell Carcinoma: An Indicator of Aggressive Cancer Behavior

ICU Risk Stratification Models Feasible for Use in Sub-Saharan Africa Show Poor Discrimination in Malawi: A Prospective Cohort Study

Nasogastric Tube on Demand is Rarely Necessary After Pancreatoduodenectomy Within an Enhanced Recovery Pathway

Reporting Quality of Journal Abstracts for Surgical Randomized Controlled Trials Before and After the Implementation of the CONSORT Extension for Abstracts