Review of surgical management of aldosterone secreting tumours of the adrenal cortex

Aims: To evaluate the investigation and surgical management of primary hyperaldosteronism. Retrospective case note analysis of thirty-three patients who underwent adrenalectomy for primary hyperaldosteronism between 1982 and 2001 and a current relevant literature review. Methods: The records of twel...

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Bibliographic Details
Published in:European journal of surgical oncology 2003-06, Vol.29 (5), p.467-474
Main Authors: Harris, D.A., Au-Yong, I., Basnyat, P.S., Sadler, G.P., Wheeler, M.H.
Format: Article
Language:English
Subjects:
Adenoma - surgery
Adolescent
Adrenal Gland Neoplasms - surgery
adrenalectomy
Adrenalectomy - methods
Adult
Aged
Aged, 80 and over
Carcinoma - surgery
Chi-Square Distribution
Female
Humans
hyperaldosteronism
Hyperaldosteronism - complications
Hyperaldosteronism - surgery
hypertension
Hypertension - etiology
laparoscopy
Male
Middle Aged
Retrospective Studies
Statistics, Nonparametric
Treatment Outcome
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Summary:Aims: To evaluate the investigation and surgical management of primary hyperaldosteronism. Retrospective case note analysis of thirty-three patients who underwent adrenalectomy for primary hyperaldosteronism between 1982 and 2001 and a current relevant literature review. Methods: The records of twelve male and twenty-one female patients, age range 18 to 81 (mean 48 years) were reviewed. Eleven operations were performed by an open approach and twenty-two laparoscopically. Preoperative investigations included computed tomography (CT), magnetic resonance imaging (MRI), selective venous sampling and seleno-cholesterol isotope scanning, along with biochemical and hormonal assays. Twenty-six benign adenomas, three nodular hyperplastic lesions, one primary adrenal hyperplasia and three functional carcinomas were excised. Mean follow up was 12 months. Results: Patients had a mean blood pressure of 185/107 mmHg for 6.2 years mean duration. The mean severity of hypokalaemia was 2.7 mmol/l. Sensitivity of CT scanning was 85%, and of MRI 86%. Fifty percent of seleno-cholesterol scans were accurate. Mean operating time was 158 min for laparoscopic adrenalectomy whilst open surgery took 129 min ( p=0.2, NS). Two cases commenced laparoscopically required open access for control of primary haemorrhage whilst one other bleed was managed via the operating ports. Mean postoperative stay was significantly shorter for the laparoscopic group (3 days compared with 7.9 days, p
ISSN:0748-7983
1532-2157
DOI:10.1016/S0748-7983(03)00051-9