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World Journal of Surgery

Published in:

01-07-2014

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

Authors: Augustin Pirvu, Nora Naem, Jean Philippe Baguet, Frédéric Thony, Olivier Chabre, Philippe Chaffanjon

Published in: World Journal of Surgery | Issue 7/2014

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.

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Title: Is Adrenal Venous Sampling Mandatory before Surgical Decision in Case of Primary Hyperaldosteronism?
Authors: Augustin Pirvu
Nora Naem
Jean Philippe Baguet
Frédéric Thony
Olivier Chabre
Philippe Chaffanjon
Publication date: 01-07-2014
Publisher: Springer US
Published in: World Journal of Surgery / Issue 7/2014
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-014-2461-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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