Skip to main content

Advertisement

SpringerLink
Log in

Adrenal Histologic Findings Show No Difference in Clinical Presentation and Outcome in Primary Hyperaldosteronism

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Primary hyperaldosteronism is most commonly due to a solitary cortical adenoma. Thus, some surgeons have suggested a subtotal adrenalectomy is a reasonable approach when a mass can be identified. On the other hand, adrenal vein sampling (AVS) is being used more frequently to distinguish patients with unilateral disease for adrenalectomy, even if a discrete mass is not identified on axial imaging. In these cases, surgical pathology may reveal a cortical adenoma, a cortical adenoma with hyperplasia, or cortical hyperplasia. The goal of this study was to compare the presentation and outcome among patients undergoing adrenalectomy and found to have different histologic features.

Methods

We performed a retrospective analysis of 136 patients with primary hyperaldosteronism. A total of 95 patients had an adrenalectomy for unilateral disease. The preoperative clinical and laboratory, and postoperative outcome of the three aforementioned histologic groups were compared.

Results

A total of 95 patients underwent an adrenalectomy. We found no significant difference in age, gender, body mass index, duration of hypertension, number of antihypertensive medications, serum aldosterone level, serum renin level, or adrenal vein sampling ratios among the three histologic categories. We also found no significant difference among the three categories in postoperative cure rate.

Conclusion

The rate of unilateral hyperplasia in patients with primary hyperaldosteronism (16 %) is likely higher than previously reported, which may be due to the increasing use of AVS. The clinical presentation and outcome of patients regardless of the histologic findings are similar. Our data also suggests that subtotal adrenalectomy would not be appropriate in patients with primary hyperaldosteronism.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Reference

  1. Conn JW, Louis LH. Primary aldosteronism: a new clinical entity. Trans Assoc Am Physicians. 1955;68:215–31, discussion, 231–3.

    PubMed  CAS  Google Scholar 

  2. Young WF. Primary aldosteronism: renaissance of a syndrome. Clin Endocrinol (Oxf). 2007;66:607–18.

    Article  CAS  Google Scholar 

  3. Schwartz GL, Turner ST. Screening for primary aldosteronism in essential hypertension: diagnostic accuracy of the ratio of plasma aldosterone concentration to plasma renin activity. Clin Chem. 2005;51:386–94.

    Article  PubMed  CAS  Google Scholar 

  4. Stowasser M, Sharman J, Leano R, Gordon RD, Ward G, Cowley D, et al. Evidence for abnormal left ventricular structure and function in normotensive individuals with familial hyperaldosteronism type I. J Clin Endocrinol Metab. 2005;90:5070–6.

    Article  PubMed  CAS  Google Scholar 

  5. Milliez P, Girerd X, Plouin PF, Blacher J, Safar ME, Mourad JJ. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol. 2005;45:1243–8.

    Article  PubMed  CAS  Google Scholar 

  6. Herrada AA, Campino C, Amador CA, Michea LF, Fardella CE, Kalergis AM. Aldosterone as a modulator of immunity: implications in the organ damage. J Hypertens. 2011;29:1684–92.

    Article  PubMed  CAS  Google Scholar 

  7. Tresallet C, Salepcioglu H, Godiris-Petit G, Hoang C, Girerd X, Menegaux F. Clinical outcome after laparoscopic adrenalectomy for primary hyperaldosteronism: the role of pathology. Surgery. 2010;148:129–34.

    Article  PubMed  Google Scholar 

  8. Webb R, Mathur A, Chang R, Baid S, Nilubol N, Libutti SK, et al. What is the best criterion for the interpretation of adrenal vein sample results in patients with primary hyperaldosteronism? Ann Surg Oncol. 2012;19:1881–6.

    Article  PubMed  Google Scholar 

  9. Mathur A, Kemp CD, Dutta U, Baid S, Ayala A, Chang RE, et al. Consequences of adrenal venous sampling in primary hyperaldosteronism and predictors of unilateral adrenal disease. J Am Coll Surg. 2010;211:384–90.

    Article  PubMed  Google Scholar 

  10. Lonborg J, Mathur M, Grieve SM, Bhindi R, Ward M, Lowe H, et al. Constrictive pericarditis diagnosed by cardiac magnetic resonance. J Am Coll Cardiol. 2010;56:e39.

    Article  PubMed  Google Scholar 

  11. Young WF, Stanson AW, Thompson GB, Grant CS, Farley DR, van Heerden JA. Role for adrenal venous sampling in primary aldosteronism. Surgery. 2004;136:1227–35.

    Article  PubMed  Google Scholar 

  12. Magill SB, Raff H, Shaker JL, Brickner RC, Knechtges TE, Kehoe ME, et al. Comparison of adrenal vein sampling and computed tomography in the differentiation of primary aldosteronism. J Clin Endocrinol Metab. 2001;86:1066–71.

    Article  PubMed  CAS  Google Scholar 

  13. Steichen O, Zinzindohoue F, Plouin PF, Amar L. Outcomes of adrenalectomy in patients with unilateral primary aldosteronism: a review. Horm Metab Res. 2012;44:221–7.

    Article  PubMed  CAS  Google Scholar 

  14. Sawka AM, Young WF, Thompson GB, Grant CS, Farley DR, Leibson C, et al. Primary aldosteronism: factors associated with normalization of blood pressure after surgery. Ann Intern Med. 2001;135:258–61.

    PubMed  CAS  Google Scholar 

  15. Lumachi F, Ermani M, Basso SM, Armanini D, Iacobone M, Favia G. Long-term results of adrenalectomy in patients with aldosterone-producing adenomas: multivariate analysis of factors affecting unresolved hypertension and review of the literature. Am Surg. 2005;71:864–9.

    PubMed  Google Scholar 

  16. Satoh F, Abe T, Tanemoto M, Nakamura M, Abe M, Uruno A, et al. Localization of aldosterone-producing adrenocortical adenomas: significance of adrenal venous sampling. Hypertens Res. 2007;30:1083–95.

    Article  PubMed  CAS  Google Scholar 

  17. Pang TC, Bambach C, Monaghan JC, Sidhu SB, Bune A, Delbridge LW, et al. Outcomes of laparoscopic adrenalectomy for hyperaldosteronism. ANZ J Surg. 2007;77:768–73.

    Article  PubMed  Google Scholar 

  18. Zarnegar R, Lee J, Brunaud L, Lindsay S, Kebebew E, Clark OH, et al. Good blood pressure control on antihypertensives, not only response to spironolactone, predicts improved outcome after adrenalectomy for aldosteronoma. Surgery. 2007;142:921–9.

    Article  PubMed  CAS  Google Scholar 

  19. Zarnegar R, Young WF, Jr., Lee J, Sweet MP, Kebebew E, Farley DR, et al. The aldosteronoma resolution score: predicting complete resolution of hypertension after adrenalectomy for aldosteronoma. Ann Surg. 2008;247:511–8.

    Article  PubMed  Google Scholar 

  20. Quillo AR, Grant CS, Thompson GB, Farley DR, Richards ML, Young WF. Primary aldosteronism: results of adrenalectomy for nonsingle adenoma. J Am Coll Surg. 2011;213:106–12, discussion 112–3.

    Article  PubMed  Google Scholar 

  21. Dye NV, Litton NJ, Varma M, Isley WL. Unilateral adrenal hyperplasia as a cause of primary aldosteronism. South Med J. 1989;82:82–6.

    Article  PubMed  CAS  Google Scholar 

  22. Ganguly A, Yum MN, Pratt JH, Weinberger MH, Grim CE, Yune HY, et al. Unilateral hypersecretion of aldosterone associated with adrenal hyperplasia as a cause of primary aldosteronism. Clin Exp Hypertens A. 1983;5:1635–58.

    Article  PubMed  CAS  Google Scholar 

  23. Banks WA, Kastin AJ, Biglieri EG, Ruiz AE. Primary adrenal hyperplasia: a new subset of primary hyperaldosteronism. J Clin Endocrinol Metab. 1984;58:783–5.

    Article  PubMed  CAS  Google Scholar 

  24. Ross EJ. Conn’s syndrome due to adrenal hyperplasia with hypertrophy of zona glomerulosa, relieved by unilateral adrenalectomy. Am J Med. 1965;39:994–1002.

    Article  PubMed  CAS  Google Scholar 

  25. Sasagawa I, Nakada T, Hashimoto T, Kato T, Suzuki H, Ishigooka M, et al. Unilateral diffuse adrenal hyperplasia masquerading as aldosterone-producing adenoma in primary hyperaldosteronism. Urol Int. 1993;50:218–22.

    Article  PubMed  CAS  Google Scholar 

  26. Ganguly A, Bergstein J, Grim CE, Yum MN, Weinberger MH. Childhood primary aldosteronism due to an adrenal adenoma: preoperative localization by adrenal vein catheterization. Pediatrics. 1980;65:605–9.

    PubMed  CAS  Google Scholar 

  27. Otsuka F, Otsuka-Misunaga F, Koyama S, Yamanari H, Ogura T, Ohe T, et al. Hormonal characteristics of primary aldosteronism due to unilateral adrenal hyperplasia. J Endocrinol Invest. 1998;21:531–6.

    PubMed  CAS  Google Scholar 

  28. Haenel LCt, Hermayer KL. A case of unilateral adrenal hyperplasia: the diagnostic dilemma of hyperaldosteronism. Endocr Pract. 2000;6:153–8.

    Google Scholar 

  29. Morioka M, Kobayashi T, Sone A, Furukawa Y, Tanaka H. Primary aldosteronism due to unilateral adrenal hyperplasia: report of two cases and review of the literature. Endocr J. 2000;47:443–9.

    Article  PubMed  CAS  Google Scholar 

  30. Oberfield SE, Levine LS, Firpo A, Lawrence D Sr, Stoner E, Levy DJ, et al. Primary hyperaldosteronism in childhood due to unilateral macronodular hyperplasia. Case report. Hypertension. 1984;6:75–84.

    Article  PubMed  CAS  Google Scholar 

  31. Pignatelli D, Falcao H, Coimbra-Peixoto A, Cruz F. Unilateral adrenal hyperplasia. South Med J. 1994;87:664–7.

    Article  PubMed  CAS  Google Scholar 

  32. Mendlowitz M. A case of predominantly unilateral pseudoprimary hyperaldosteronism. Mt Sinai J Med. 1982;49:76–7.

    PubMed  CAS  Google Scholar 

  33. Goh BK, Tan YH, Chang KT, Eng PH, Yip SK, Cheng CW. Primary hyperaldosteronism secondary to unilateral adrenal hyperplasia: an unusual cause of surgically correctable hypertension. A review of 30 cases. World J Surg. 2007;31:72–9.

    Article  PubMed  Google Scholar 

  34. Weinberger MH, Grim CE, Hollifield JW, Kem DC, Ganguly A, Kramer NJ, et al. Primary aldosteronism: diagnosis, localization, and treatment. Ann Intern Med. 1979;90:386–95.

    PubMed  CAS  Google Scholar 

  35. Kem DC, Tang K, Hanson CS, Brown RD, Painton R, Weinberger MH, et al. The prediction of anatomical morphology of primary aldosteronism using serum 18-hydroxycorticosterone levels. J Clin Endocrinol Metab. 1985;60:67–73.

    Article  PubMed  CAS  Google Scholar 

  36. Rao A, Melby JC. Idiopathic hyperplasia of the adrenal gland behaving like an aldosterone producing adenoma. J Endocrinol Invest. 1997;20:29–31.

    PubMed  CAS  Google Scholar 

  37. Chen LG, Lee TI, Lin HD, Wang HC, Liu WY, Tang KT. Primary aldosteronism due to unilateral adrenal hyperplasia: a case report. Zhonghua Yi Xue Za Zhi (Taipei). 1997;59:114–20.

    CAS  Google Scholar 

  38. Mansoor GA, Malchoff CD, Arici MH, Karimeddini MK, Whalen GF. Unilateral adrenal hyperplasia causing primary aldosteronism: limitations of I-131 norcholesterol scanning. Am J Hypertens. 2002;15:459–64.

    Article  PubMed  Google Scholar 

  39. Katayama Y, Takata N, Tamura T, Yamamoto A, Hirata F, Yasuda H, et al. A case of primary aldosteronism due to unilateral adrenal hyperplasia. Hypertens Res. 2005;28:379–84.

    Article  PubMed  Google Scholar 

  40. Omura M, Sasano H, Fujiwara T, Yamaguchi K, Nishikawa T. Unique cases of unilateral hyperaldosteronemia due to multiple adrenocortical micronodules, which can only be detected by selective adrenal venous sampling. Metabolism. 2002;51:350–5.

    Article  PubMed  CAS  Google Scholar 

  41. Hirono Y, Doi M, Yoshimoto T, Kanno K, Himeno Y, Taki K, et al. A case with primary aldosteronism due to unilateral multiple adrenocortical micronodules. Endocr J. 2005;52:435–9.

    Article  PubMed  Google Scholar 

  42. Omura M, Saito J, Yamaguchi K, Kakuta Y, Nishikawa T. Prospective study on the prevalence of secondary hypertension among hypertensive patients visiting a general outpatient clinic in Japan. Hypertens Res. 2004;27:193–202.

    Article  PubMed  Google Scholar 

  43. Murashima M, Trerotola SO, Fraker DL, Han D, Townsend RR, Cohen DL. Adrenal venous sampling for primary aldosteronism and clinical outcomes after unilateral adrenalectomy: a single-center experience. J Clin Hypertens (Greenwich). 2009;11:316–23.

    Article  Google Scholar 

  44. Walz MK, Gwosdz R, Levin SL, Alesina PF, Suttorp AC, Metz KA, et al. Retroperitoneoscopic adrenalectomy in Conn’s syndrome caused by adrenal adenomas or nodular hyperplasia. World J Surg. 2008;32:847–53.

    Article  PubMed  Google Scholar 

  45. Proye CA, Mulliez EA, Carnaille BM, Lecomte-Houcke M, Decoulx M, Wémeau JL, et al. Essential hypertension: first reason for persistent hypertension after unilateral adrenalectomy for primary aldosteronism? Surgery. 1998;124:1128–33.

    Article  PubMed  CAS  Google Scholar 

  46. Celen O, O’Brien MJ, Melby JC, Beazley RM. Factors influencing outcome of surgery for primary aldosteronism. Arch Surg. 1996;131:646–50.

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosure

No financial disclosures.

Author information

Authors and Affiliations

  1. Endocrine Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland

    Allison B. Weisbrod MD, MPH, Richard C. Webb MD, Aarti Mathur MD, Naris Nilubol MD & Electron Kebebew MD

  2. Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland

    Stephanie Barak MD & Martha Quezado MD

  3. Program of Reproductive and Adult Endocrinology, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland

    Smita Baid Abraham MD

  4. Section on Endocrinology and Genetics, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland

    Constantine A. Stratakis MD, D.Sc

Authors
  1. Allison B. Weisbrod MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Richard C. Webb MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aarti Mathur MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephanie Barak MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Smita Baid Abraham MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Naris Nilubol MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Martha Quezado MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Constantine A. Stratakis MD, D.Sc
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Electron Kebebew MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Allison B. Weisbrod MD, MPH.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Weisbrod, A.B., Webb, R.C., Mathur, A. et al. Adrenal Histologic Findings Show No Difference in Clinical Presentation and Outcome in Primary Hyperaldosteronism. Ann Surg Oncol 20, 753–758 (2013). https://doi.org/10.1245/s10434-012-2670-2

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-012-2670-2

Keywords

Search

Navigation