Primary hyperaldosteronism surgery: Difference between revisions
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==Overview== | ==Overview== | ||
Surgery is the mainstay of treatment for unilateral adrenal hyperplasia, aldosterone producing adenomas (APAs), adrenal carcinoma, ectopic ACTH, renin, and deoxycorticosterone secreting tumors. | |||
==Surgery== | ==Surgery== | ||
* Adrenal lesions producing excess aldosterone are treated mainly by laproscopic adrenalectomy. | |||
* Symptom resolution may take one to six months after the procedure. | |||
* Features associated with cure after adrenalectomy are:<ref name="pmid18552288">{{cite journal |vauthors=Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M, Young WF, Montori VM |title=Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline |journal=J. Clin. Endocrinol. Metab. |volume=93 |issue=9 |pages=3266–81 |year=2008 |pmid=18552288 |doi=10.1210/jc.2008-0104 |url= |issn=}}</ref> | |||
** Good response to medical therapy with spironolactone | |||
** Young age | |||
** Decreased duration of hypertension | |||
** At least one first-degree relative suffering from hypertension | |||
** Preoperative use of two or fewer antihypertensive agents | |||
** High PAC / PRA and 24-h urinary aldosterone levels | |||
== Indications == | |||
Surgery for primary hyperaldosteronism is indicated in the following:<ref name="pmid32301012">{{cite journal |vauthors=Horsley MG, Bailie GR |title=Effectiveness of theophylline monitoring by the use of serum assays |journal=J Clin Pharm Ther |volume=13 |issue=5 |pages=359–64 |year=1988 |pmid=3230101 |doi= |url= |issn=}}</ref> | |||
* Unilateral adrenal hyperplasia | |||
* Aldosterone producing adenoma (APA) | |||
* Adrenal carcinoma | |||
* Ectopic ACTH | |||
* Reninoma | |||
* Deoxycorticosterone secreting tumors | |||
== Contraindications == | |||
Surgery is contraindicated in the following situations: | |||
* Hemodynamic instability | |||
* Severe hypokalemia | |||
== Post-surgical management == | |||
Postoperative management of primary hyperaldosteronism includes the following:<ref name="pmid3230101">{{cite journal |vauthors=Horsley MG, Bailie GR |title=Effectiveness of theophylline monitoring by the use of serum assays |journal=J Clin Pharm Ther |volume=13 |issue=5 |pages=359–64 |year=1988 |pmid=3230101 |doi= |url= |issn=}}</ref> | |||
* PRN use of anti-hypertensives and anti-hypokalemics | |||
* Anti-hypokalemics can be continued if serum potassium is < 3.0 meq / l | |||
* PAC / PRA should be recorded immediately postoperatively on day one, to ensure surgical cure. | |||
* Intra-venous saline load test (SLT) or a fludrocortisone suppression test (FST) can be conducted three months after surgery. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 14:55, 11 July 2017
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Risk calculators and risk factors for Primary hyperaldosteronism surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Surgery is the mainstay of treatment for unilateral adrenal hyperplasia, aldosterone producing adenomas (APAs), adrenal carcinoma, ectopic ACTH, renin, and deoxycorticosterone secreting tumors.
Surgery
- Adrenal lesions producing excess aldosterone are treated mainly by laproscopic adrenalectomy.
- Symptom resolution may take one to six months after the procedure.
- Features associated with cure after adrenalectomy are:[1]
- Good response to medical therapy with spironolactone
- Young age
- Decreased duration of hypertension
- At least one first-degree relative suffering from hypertension
- Preoperative use of two or fewer antihypertensive agents
- High PAC / PRA and 24-h urinary aldosterone levels
Indications
Surgery for primary hyperaldosteronism is indicated in the following:[2]
- Unilateral adrenal hyperplasia
- Aldosterone producing adenoma (APA)
- Adrenal carcinoma
- Ectopic ACTH
- Reninoma
- Deoxycorticosterone secreting tumors
Contraindications
Surgery is contraindicated in the following situations:
- Hemodynamic instability
- Severe hypokalemia
Post-surgical management
Postoperative management of primary hyperaldosteronism includes the following:[3]
- PRN use of anti-hypertensives and anti-hypokalemics
- Anti-hypokalemics can be continued if serum potassium is < 3.0 meq / l
- PAC / PRA should be recorded immediately postoperatively on day one, to ensure surgical cure.
- Intra-venous saline load test (SLT) or a fludrocortisone suppression test (FST) can be conducted three months after surgery.
References
- ↑ Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M, Young WF, Montori VM (2008). "Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline". J. Clin. Endocrinol. Metab. 93 (9): 3266–81. doi:10.1210/jc.2008-0104. PMID 18552288.
- ↑ Horsley MG, Bailie GR (1988). "Effectiveness of theophylline monitoring by the use of serum assays". J Clin Pharm Ther. 13 (5): 359–64. PMID 3230101.
- ↑ Horsley MG, Bailie GR (1988). "Effectiveness of theophylline monitoring by the use of serum assays". J Clin Pharm Ther. 13 (5): 359–64. PMID 3230101.