Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2014, 158(4):583-590 | DOI: 10.5507/bp.2014.059

Outcomes of adrenalectomy in patients with primary hyperaldosteronism - a single centre experience

Igor Hartmann^a, Michal Grepl^a, Ales Vidlar^a, Oldrich Smakal^a, Jan Vaclavik^b, Zdenek Frysak^c, Martin Dolezel^d,e,f, Vladimir Student^a

^a Department of Urology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic

^b Department of Internal Medicine I - Cardiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc

^c Department of Internal Medicine III - Nephrology, Rheumatology and Endocrinology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc

^d Multiscan α Pardubice Regional Hospital, Pardubice

^e Department of Oncology, 1^st Faculty of Medicine, Charles University in Prague

^f Department of Oncology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc

Introduction: Primary hyperaldosteronism is a common cause of secondary hypertension. In patients with proven unilateral overproduction of aldosterone adrenalectomy can cure hyperaldosteronism with high probability and a positive effect on hypertension. The aim of the study was to determine the effects of unilateral adrenalectomy on blood pressure and laboratory parameters. The secondary objective was to identify parameters that would allow the prediction of hypertension cure.

Methods: We performed a cross-sectional analysis of the data of patients who underwent unilateral adrenalectomy for primary aldosteronism at the Department of Urology of University Hospital Olomouc in the years 2000-2011. We assesed the preoperative clinical conditions of patients, the results of biochemical and radiological examinations, course of the surgery and post-operative course including laboratory and clinical parameters during the 12 months postoperatively.

Results: 62 patients underwent adrenalectomy for primary aldosteronism in this period. Four patients were excluded from the study due to surprising histology (myelolipoma in 2, carcinoma in 2), seven patients had incomplete postoperative data. The statistical analysis therefore included 51 patients, of which 57% were females. CT or MRI was performed in all patients; 63% patients underwent superselective catheterization of adrenal veins (AVS). Adrenalectomy was performed in all cases laparoscopically. Histology most often showed adrenal hyperplasia (59%), adenoma was detected in 37% and adenoma on the basis of micronodular hyperplasia in 4%. Twelve months after surgery the antihypertensive drugs were discontinued in 17/51 (33%) and the number or dose of antihypertensive drugs was reduced in 25/51 (49%). Normokalemia and normalisation of the aldosterone-renin ratio (ARR) was detected in 92% and 84% of the patients. Performing AVS did not statistically significantly influence the rate of blood pressure control or normalization of ARR, which is probably due to small study size. This study demonstrated a better effect of surgery on blood pressure in younger patients.

Conclusions: Unilateral adrenalectomy had a positive effect in 82% of the patients operated for primary aldosteronism and lead to either blood pressure normalization or reduction of the antihypertensive medication.

Keywords: primary hyperaldosteronism, adrenalectomy, surgery, adrenal venous sampling, hypertension, adrenal adenoma, and adrenal hyperplasia

Received: March 11, 2014; Accepted: November 11, 2014; Prepublished online: December 2, 2014; Published: December 9, 2014  Show citation