Abstract
The objective of this study was to assess the long-term effects of adrenalectomy on the blood pressure and antihypertensive medication in patients with primary aldosteronism (PA). Twenty-four patients (15 female and 9 male) with a mean age of 48.3 ± 10.8 years underwent surgery for PA in our institution between 1988 and 2001. All subjects were re-examined with a complete clinical work-up after a mean follow-up period of 86 ± 48 months, including blood pressure readings (<140/90 mmHg defined as normal), endocrine adrenal function, and specific medication. All patients suffered from hypertension (onset 8.5 ± 5.5 years prior to surgery). In 92% of the patients, hypokalemia was present (onset 2.0 ± 2.6 years prior to surgery). The histopathologic examinations revealed unilateral adenomas in 23 patients and a bilateral hyperplasia in one patient. At follow-up, 33% (8) of the patients were completely cured (normal blood pressure and no antihypertensive treatment), with seven of these eight patients being under 50 years of age at the time of surgery. One patient revealed a contralateral aldosterone-secreting adrenal adenoma during the subsequent endocrine and imaging examination 44 months after the first operation. Despite normalized plasma-aldosterone concentration (PAC), plasma-renin-activity (PRA) and serum potassium levels, a long-lasting insufficiently treated hypertension due to the delayed diagnosis in patients with PA may explain the persistent blood pressure elevation, indicating the necessity of a life-long, regular control of the blood pressure and antihypertensive medication.
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References
JW Conn (1955) ArticleTitlePrimary aldosteronism: a new clinical syndrome J. Lab. Clin. Med. 45 6–17
A Ganguly (1998) ArticleTitlePrimary hyperaldosteronism N. Engl. J. Med. 339 1828–1834
MH Wheeler DA Harris (2003) ArticleTitleDiagnosis and management of primary aldosteronism World J. Surg. 27 627–631 Occurrence Handle10.1007/s00268-003-7069-6
DA Harris I Au-Yong PS Basnyat et al. (2003) ArticleTitleReview of surgical management of aldosterone secreting tumours of the adrenal cortex Eur J. Surg. Oncol. 29 467–474 Occurrence Handle10.1016/S0748-7983(03)00051-9
InstitutionalAuthorNameWHO/ISH-Guidelines-Subcommittee (1999) ArticleTitle1999 World Health Organization-International Society of Hypertension Guidelines for the management of hypertension. Guidelines Subcommittee J. Hypertens. 17 151–183
G Favia F Lumachi V Scarpa et al. (1992) ArticleTitleAdrenalectomy in primary aldosteronism: a long-term follow-up study in 52 patients World J. Surg. 16 680–683
JD Blumenfeld JE Sealey Y Schlussel et al. (1994) ArticleTitleDiagnosis and treatment of primary hyperaldosteronism Ann. Intern. Med. 121 877–885
T Jeck B Weisser T Mengden et al. (1994) ArticleTitlePrimary aldosteronism: difference in clinical presentation and long-term follow-up between adenoma and bilateral hyperplasia of the adrenal glands Clin. Invest. 72 979–984 Occurrence Handle10.1007/BF00577740
RJ Weigel SA Wells C Gunnells et al. (1994) ArticleTitleSurgical treatment of primary hyperaldosteronism Ann. Surg. 219 347–352
O Celen MJ O’Brien JC Melby et al. (1996) ArticleTitleFactors influencing outcome of surgery for primary aldosteronism Arch. Surg. J. 131 646–650
CY Lo PC Tam AWC Kung et al. (1996) ArticleTitlePrimary aldosteronism. Results of surgical treatment Ann. Surg. 224 125–130 Occurrence Handle10.1097/00000658-199608000-00003
CA Proye EAR Mulliez BML Carnaille et al. (1998) ArticleTitleEssential hypertension: first reason for persistent hypertension after unilateral adrenalectomy for primary aldosteronism? Surgery 124 1128–1133 Occurrence Handle10.1067/msy.1998.93108
M Puccini P Iacconi G Bernini et al. (1998) ArticleTitleConn syndrome: 14 years experience from two European centres Eur. Surg. 164 811–817 Occurrence Handle10.1080/110241598750005200
J Siren M Valimaki K Huikuri et al. (1998) ArticleTitleAdrenalectomy for primary aldosteronism: long-term follow-up study in 29 patients World J. Surg. 22 418–421 Occurrence Handle10.1007/s002689900407
Y Fukudome K Fujii H Arima (2002) ArticleTitleDiscriminating factors for recurrent hypertension in patients with primary aldosteronism after adrenalectomy Hypertens. Res. 25 11–18 Occurrence Handle10.1291/hypres.25.11
T Obara Y Ito T Okamoto et al. (1992) ArticleTitleRisk factors associated with postoperative persistent hypertension in patients with primary aldosteronism Surgery 112 987–993
WT Shen RC Lim AE Siperstein et al. (1999) ArticleTitleLaparoscopic vs. open adrenalectomy for the treatment of primary hyperaldosteronism Arch. Surg. 134 628–631 Occurrence Handle10.1001/archsurg.134.6.628 Occurrence Handle1:STN:280:DyaK1M3psVaqsA%3D%3D Occurrence Handle10367872
M Meria BF Kempf JF Hermieu et al. (2003) ArticleTitleLaparoscopic management of primary hyperaldosteronism: clinical experience with 212 cases J. Urol. 169 32–35 Occurrence Handle10.1097/00005392-200301000-00008 Occurrence Handle12478096
AM Sawka WF Young SuffixJr. GB Thompson et al. (2001) ArticleTitlePrimary aldosteronism: factors associated with normalization of blood pressure after surgery Ann. Intern. Med. 135 258–261
T Nakada Y Kubota I Sasagawa et al. (1995) ArticleTitleTherapeutic outcome of primary aldosteronism: adrenalectomy versus enucleation of aldosterone-producing adenoma J. Urol. 153 1775–1780 Occurrence Handle10.1097/00005392-199506000-00004 Occurrence Handle1:STN:280:ByqB2s7nsVM%3D Occurrence Handle7752314
M Sywak JL Pasieka (2002) ArticleTitleLong-term follow-up and cost benefit of adrenalectomy in patients with primary hyperaldosteronism Br. J. Surg. 89 1587–1593 Occurrence Handle10.1046/j.1365-2168.2002.02261.x
D Simon PE Goretzki A Lollert et al. (1993) ArticleTitlePersistent hypertension after successful adrenal operation Surgery 114 1189–1195
P Sapienza A Cavallaro (1999) ArticleTitlePersistent hypertension after removal of adrenal tumours Eur. J. Surg. 165 187–192 Occurrence Handle10.1080/110241599750007027
K Hiramatsu T Yamada Y Yukimura et al. (1981) ArticleTitleA screening test to identify aldosterone-producing adenoma by measuring plasma renin activity. Results in hypertensive patients Arch. Intern. Med. 141 1589–1593 Occurrence Handle10.1001/archinte.141.12.1589
RD Gordon M Stowasser TJ Tunny et al. (1994) ArticleTitleHigh incidence of primary aldosteronism in 199 patients referred with hypertension Clin. Exp. Pharmacol. Physiol. 21 315–318
CE Fardella L Mosso C Gomez-Sanchez et al. (2000) ArticleTitlePrimary hyperaldosteronism in essential hypertensives: prevalence, biochemical profile, and molecular biology J. Clin. Endocrinol. Metab. 85 1863–1867 Occurrence Handle10.1210/jc.85.5.1863
K Loh E Koay M Khaw et al. (2000) ArticleTitlePrevalence of primary aldosteronism among Asian hypertensive patients in Singapore J. Clin. Endocrinol. Metab. 85 2854–2859 Occurrence Handle10.1210/jc.85.8.2854
NM Kaplan (2001) ArticleTitleCautions over the current epidemic of primary aldosteronism Lancet 357 953–954 Occurrence Handle10.1016/S0140-6736(00)04223-9
JD Blumenfeld ED Vaughan SuffixJr (1999) ArticleTitleDiagnosis and treatment of primary hyperaldosteronism World J. Urol. 17 15–21 Occurrence Handle10.1007/s003450050099
M Quinkler J Lepenies S Diederich (2002) ArticleTitlePrimary hyperaldosteronism Exp. Clin. Endocrinol. Diabetes 110 262–271 Occurrence Handle10.1055/s-2002-34588
PO Lim E Dow G Brennan et al. (2000) ArticleTitleHigh prevalence of primary aldosteronism in the Tayside hypertension clinic population J. Hum. J. Hypertens. 14 311–315 Occurrence Handle10.1038/sj.jhh.1001013
DA Calhoun MK Nishizaka MA Zaman et al. (2002) ArticleTitleHyperaldosteronism among black and white subjects with resistant hypertension Hypertension 40 892–896 Occurrence Handle10.1161/01.HYP.0000040261.30455.B6
InstitutionalAuthorNameJoint National Committee (1997) ArticleTitleThe sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure Arch. Intern. Med. 157 2413–2446
SB Magill H Raff JL Shaker et al. (2001) ArticleTitleComparison of adrenal vein sampling and computed tomography in the differentiation of primary aldosteronism J. Clin. Endocrinol. Metab. 86 1066–1071 Occurrence Handle10.1210/jc.86.3.1066
KYY Kok SKS Yapp (2002) ArticleTitleLaparoscopic adrenal-sparing surgery for primary hyperaldosteronism due to aldosterone-producing adenoma Surg. Endosc. 16 108–111 Occurrence Handle10.1007/s00464-001-8127-5 Occurrence Handle1:STN:280:DC%2BD383isFCqsQ%3D%3D Occurrence Handle11961617
K Jescke G Janetschek R Peschel et al. (2003) ArticleTitleLaparoscopic partial adrenalectomy in patients with aldosterone-producing adenomas: indications, technique, and results Urology 61 69–72 Occurrence Handle10.1016/S0090-4295(02)02240-9 Occurrence Handle1:STN:280:DC%2BD3s%2FltFWksQ%3D%3D Occurrence Handle12559268
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Meyer, A., Brabant, G. & Behrend, M. Long-term Follow-up after Adrenalectomy for Primary Aldosteronism. World J. Surg. 29, 155–159 (2005). https://doi.org/10.1007/s00268-004-7496-z
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DOI: https://doi.org/10.1007/s00268-004-7496-z