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Retroperitoneoscopic Adrenalectomy in Conn’s Syndrome Caused by Adrenal Adenomas or Nodular Hyperplasia

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Abstract

Background

In patients with primary hyperaldosteronism, solitary adrenal adenomas are an indication for surgical intervention. In contrast, adrenal hyperplasia is almost exclusively treated by drugs.

Patients and methods

In a prospective clinical study 183 patients (81 men, 102 women; age 49.6 ± 12.8 years) with Conn’s syndrome were operated on using the posterior retroperitoneoscopic approach. Tumor size ranged from 0.2 to 5.0 cm (mean 1.5 ± 0.8 cm). Final histology described a solitary adenoma in 127 patients and adrenal hyperplasia in 56 patients. Partial adrenalectomies were performed in 47 operations.

Results

The perioperative complication rate was 4%, mortality zero. In none of the cases was conversion to open surgery necessary. The mean operating time was 58 ± 32 minutes (range 20–230 minutes) and was associated with sex (p < 0.001) but not with the extent of resection (partial vs. total, p = 0.51) or with tumor size (≤1.5 vs. >1.5 cm; p = 0.43) or tumor site (p = 0.77). Median blood loss was 15 ml. Median duration of postoperative hospitalization was 4 days. After a mean follow-up of nearly 5 years, 96% of patients are normokalemic, 30% of patients are cured (normotensive without medication), and 87% showed an improvement of hypertension (normotensive without or with reduced medication). Cure of hypertension depended on the patient’s age (p < 0.001) and sex (p < 0.001), duration of hypertension (p < 0.05), and histomorphology (p < 0.001). Improvement of hypertension was not associated with any of these factors.

Conclusions

Retroperitoneoscopic removal of adrenal glands in patients with Conn’s syndrome is a safe, rapidly performed surgical procedure and can thus be considered as first choice option for treatment of both solitary adrenal adenomas and hyperplasia presenting with a clinically predominating nodule.

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Authors and Affiliations

  1. Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Kliniken Essen-Mitte, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Universität Duisburg-Essen, Henricistrasse 92, 45136, Essen, Germany

    Martin K. Walz, Roland Gwosdz, Piero F. Alesina & Frank A. Wenger

  2. Institut für Pathologie und Neuropathologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany

    Stephanie L. Levin, Anna-Carinna Suttorp, Klaus A. Metz & Kurt W. Schmid

  3. Abteilung für Endokrinologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany

    Stephan Petersenn & Klaus Mann

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  1. Martin K. Walz
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  2. Roland Gwosdz
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  3. Stephanie L. Levin
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  4. Piero F. Alesina
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  6. Klaus A. Metz
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  7. Frank A. Wenger
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Correspondence to Martin K. Walz.

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Walz, M.K., Gwosdz, R., Levin, S.L. et al. Retroperitoneoscopic Adrenalectomy in Conn’s Syndrome Caused by Adrenal Adenomas or Nodular Hyperplasia. World J Surg 32, 847–853 (2008). https://doi.org/10.1007/s00268-008-9513-0

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  • DOI: https://doi.org/10.1007/s00268-008-9513-0

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