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Paper 6 (0930)
CLINICAL OUTCOMES OF LAPAROSCOPIC ADRENALECTOMY FOR LATERALIZING NODULAR HYPERPLASIA
Background: Adrenalectomy is indicated for primary hyperaldosteronism due to presumed unilateral adrenal adenoma. Unilateral nodular adrenal hyperplasia (NAH) may mimic the biochemical characteristics of an adenoma with lateralization of aldosterone production. Although adrenalectomies for primary adrenal hyperplasia have been reported, its efficacy remains unclear. Our aim was to evaluate the outcomes of laparoscopic adrenalectomy for NAH.
The 26th Annual Meeting of the American
Association of Endocrine Surgeons
April 3rd- 5th,2005 - Paradisus Riviera Cancun.
Y. Novitsky MD, K. Kercher MD, A. Harrell MD, W. Cobb MD, M. Rosen MD, S. Jyothinagaram MD, T. Heniford MD
Carolinas Medical Center, Charlotte, NC
Methods: Retrospective analysis of consecutive patients who underwent a laparoscopic adrenalectomy for a primary hyperaldosteronism due to NAH. Outcome measures included patient demographics, peri-operative symptoms and medications, serum aldosterone and renin levels. Postoperative hypertension were defined as cured (normal BP without any medications), improved (= 50% reduction in medication use) or unchanged.
Results: From January 1999 to October 2004, 15 patients underwent a unilateral adrenalectomy for hyperaldosteronism due to lateralizing NAH. Nine (60%) patients presented with at least a 10-year history of hypertension, including 5 (33%) patients with uncontrolled hypertension (systolic blood pressure above 200 mmHg on medication). Nine (60%) patients had hypokalemia. The mean serum aldosterone level was 23.3 ± 16.6 ng/dl (range, 7.8-61.5) and the mean plasma aldosterone-to-renin ratio was 69.9 ± 49.9 (range, 9.7-127.1). The median aldosterone level on adrenal vein sampling was 442 ng/dl (range, 58-11,214) on the ipsilateral and 26 ng/dl (range, 4-489) on the contralateral side. Abdominal imaging was normal in 9 (60%) patients. At a mean follow-up of 25 (range, 4-58) months, hypertension was cured in 3 (20%), improved in 9 (60%), and unchanged in 3 patients. Multivariate analysis reveals no predictors of successful outcome. All patients were cured of hypokalemia. There was no perioperative morbidity, no conversions, and no mortalities.
Conclusions: This series demonstrates that a unilateral adrenalectomy for lateralizing NAH Results: in eradication of hypokalemia and cure or significant improvement in hypertension in 80% of those patients at a long term follow up. Given the low perioperative morbidity of laparoscopic adrenalectomy, lateralizing NAH may be an indication for adrenal resection.