Changing pattern of the intraoperative blood pressure during endoscopic adrenalectomy in patients with Conn’s syndrome

  • I. Gockel
  • A. Heintz
  • R. Kentner
  • C. Wetner
  • Th. Junginger
Original Article
First Online:
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Abstract

Background

Primary hyperaldosteronism caused by an aldosterone-producing adenoma of the adrenal gland is regarded as the most common type of endocrine hypertension. The aim of this study was to analyze the changing pattern of the intraoperative blood pressure during endoscopic adrenalectomy recorded in patients with Conn’s syndrome compared to patients with hormone-inactive incidentaloma and its possible influence by the surgical approach.

Methods

From February 1994 to March 2004, 40 patients underwent endoscopic adrenalectomy for Conn’s syndrome. All patients had arterial hypertension over a median period of 84 (5–240) months and were pretreated with an aldosterone antagonist in 76.3% and with specific antihypertensive medication in 85%. Over the same period of time, endoscopic adrenalectomy was carried out in 80 patients with incidentaloma. Of these, 41 (53.2%) displayed arterial hypertension requiring drug therapy.

Results

The adrenal gland was resected using the retroperitoneal in 25 and the transperitoneal approach in 15 patients with Conn’s syndrome. Conversion to an open procedure was required in two patients. Intraoperative increases in blood pressure necessitating antihypertensive therapy were observed in 17 of 40 patients (44.7%), in 11 of 40 patients (28.9%) blood pressure peaks of >200 mmHg (> 1 min) were noted. Differences between the preoperative and maximum intraoperative blood pressure were significant for the retroperitoneal approach only (systolic: p = 0.0001; diastolic: p = 0.0005), but not for the transperitoneal technique. The increase in intraoperative blood pressure in patients with Conn’s syndrome was significantly higher, for both systolic (p < 0.0001) and diastolic (p = 0.0037) readings, compared to that in patients with incidentaloma undergoing endoscopic adrenalectomy during the same period of time.

Conclusion

Our results demonstrate that relevant intraoperative increases in blood pressure occur in patients with Conn’s syndrome despite prior therapy with an aldosterone antagonist, necessitating specific precautionary measures during anesthesia. Intraoperative blood pressure was significantly higher for the retroperitoneal than for the transperitoneal procedure, which leads us to advocate the latter approach for endoscopic adrenalectomy.

Keywords

endoscopic adrenalectomy Conn’s syndrome incidentaloma intraoperative blood pressure transperitoneal retroperitoneal approach 
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References

  1. 1.
    Bonjer HJ, Berends FJ, Kazemier G, Steyerberg EW, de Herder WW, Bruining HA (2000) Endoscopic retroperitoneal adrenalectomy: lessons learned from 111 consecutive cases. Ann Surg 232: 796–803PubMedGoogle Scholar
  2. 2.
    Duncan III JL, Fuhrman GM, Bolton JS, Bowen JD, Richardson WS (2000) Laparoscopic adrenalectomy is superior to an open approach to treat primary hyperaldosteronism. Am Surg 66: 932–936PubMedGoogle Scholar
  3. 3.
    Fernández-Cruz L, Saenz A, Benarroch G, Astudillo E, Taurá P, Sabater L (1996) Laparoscopic unilateral and bilateral adrenalectomy for Cushing’s syndrome: transperitoneal and retroperitoneal approaches. Ann Surg 224: 727–734PubMedGoogle Scholar
  4. 4.
    Funder JW, (1997) Aldosterone, salt and cardiac fibrosis. Clin Exp Hypert 19: 885–899Google Scholar
  5. 5.
    Gockel I, Kneist W, Heintz A, Beyer J, Junginger Th (2005) Endoscopic adrenalectomy: Analysis of the transperitoneal and retroperitoneal approach — results of a prospective follow–up study. Surg Endosc 19: 569–573PubMedGoogle Scholar
  6. 6.
    Heintz A, Junginger Th, Böttger T (1995) Retroperitoneal adrenalectomy. Br J Surg 82: 215PubMedGoogle Scholar
  7. 7.
    Heintz A, Strecker U, Walgenbach S, Junginger Th (1997) Ergebnisse der endoskopischen, retroperitonealen Adrenalektomie unter besonderer Berücksichtigung des intraoperativen Verlaufs. Chirurg 68: 154–158PubMedGoogle Scholar
  8. 8.
    Irony I, Kater CE, Biglieri EG, Shackleton CHL (1990) Correctable subsets of primary aldosteronism: primary adrenal gland hyperplasia and renin responsive adenoma. Am J Hypertens 3: 576–582PubMedGoogle Scholar
  9. 9.
    Kneist W, Vetter G, Kann P, Jaursch-Hancke, Heintz A, Hommel G, Junginger Th (2004) Transperitoneale oder retroperitoneale Adrenalektomie. Ergebnisse einer prospektiven Verlaufsbeobachtung. Chirurg 75: 1098–1103PubMedGoogle Scholar
  10. 10.
    Magill SB, Raff H, Shaker JL, Brickner RC, Knechtges TE, Kehoe ME, Findling JW (2001) Comparison of adrenal vein sampling and computed tomography in the differentiation of primary aldosteronism. J Clin Endocrinol Metab 86: 1066–1071CrossRefPubMedGoogle Scholar
  11. 11.
    Meria P, Kempf BF, Hermieu JF, Plouin PF, Duclos JM (2003) Laparoscopic management of primary hyperaldosteronism: clinical experience with 212 cases. J Urol 169: 32–35CrossRefPubMedGoogle Scholar
  12. 12.
    Sawka AM, Young WF, Thompson GB, Grant CS, Parley DR, Leibson C, van Heerden JA (2001) Primary aldosteronism: factors associated with normalization of blood pressure after surgery. Ann Intern Med 135: 258–261PubMedGoogle Scholar
  13. 13.
    Shen WT, Lim RC, Siperstein AE, Clark OH, Schecter WP, Hunt TK, Horn JK, Duh QY (1999) Laparoscopic versus open adrenalectomy for the treatment of primary hyperaldosteronism. Arch Surg 134: 628–631PubMedGoogle Scholar
  14. 14.
    Shipton EA, Hugo JM (1982) Primary aldosteronism and its importance to the anaesthesist. S Afr Med J 62: 60–63PubMedGoogle Scholar
  15. 15.
    Siren J, Haglund C, Huikuri K, Sivula A, Haapiainen R (1999) Laparoscopic adrenalectomy for primary aldosteronism: clinical experience in 12 patients. Surg Laparosc Endosc 9: 9–13CrossRefPubMedGoogle Scholar
  16. 16.
    Sunman W, Rothwell M, Sever PS (1992) Conn’s syndrome can cause malignant hypertension. J Hum Hypertens 6: 75–76PubMedGoogle Scholar
  17. 17.
    Takeda M, (2000) Laparoscopic adrenalectomy: transperitoneal versus retroperitoneal approaches. Biomed Phamacother 54(Suppl 1): 207s–210sGoogle Scholar
  18. 18.
    Takeda M, Go H, Imai T, Nishiyama T, Morishita H (1994) Laparoscopic adrenalectomy for primary aldosteronism: report of initial ten cases. Surgery 115: 621–625PubMedGoogle Scholar
  19. 19.
    Wheeler MH, Harris DA (2003) Diagnosis and management of primary aldosteronism. World J Surg 27: 627–631CrossRefPubMedGoogle Scholar
  20. 20.
    Young WF Jr, (2003) Minireview: Primary aldosteronism—changing concepts in diagnosis and treatment. Endocrinology 144: 2208–2213PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • I. Gockel
    • 1
  • A. Heintz
    • 1
  • R. Kentner
    • 2
  • C. Wetner
    • 2
  • Th. Junginger
    • 1
  1. 1.Department of General and Abdominal SurgeryJohannes Gutenberg-UniversityGermany
  2. 2.Department of AnaesthesiologyJohannes Gutenberg-UniversityGermany

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