Primary hyperaldosteronism surgery: Difference between revisions
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Adrenal lesions producing excess aldosterone are treated mainly by laproscopic adrenalectomy. Retroperitoneoscopic removal of adrenal glands in patients with primary hyperaldosteronism (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.<ref name="pmid18343972">{{cite journal |vauthors=Walz MK, Gwosdz R, Levin SL, Alesina PF, Suttorp AC, Metz KA, Wenger FA, Petersenn S, Mann K, Schmid KW |title=Retroperitoneoscopic adrenalectomy in Conn's syndrome caused by adrenal adenomas or nodular hyperplasia |journal=World J Surg |volume=32 |issue=5 |pages=847–53 |year=2008 |pmid=18343972 |doi=10.1007/s00268-008-9513-0 |url= |issn=}}</ref>. Symptom resolution may take one to six months after the procedure. | Adrenal lesions producing excess aldosterone are treated mainly by laproscopic adrenalectomy. Retroperitoneoscopic removal of adrenal glands in patients with primary hyperaldosteronism (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.<ref name="pmid18343972">{{cite journal |vauthors=Walz MK, Gwosdz R, Levin SL, Alesina PF, Suttorp AC, Metz KA, Wenger FA, Petersenn S, Mann K, Schmid KW |title=Retroperitoneoscopic adrenalectomy in Conn's syndrome caused by adrenal adenomas or nodular hyperplasia |journal=World J Surg |volume=32 |issue=5 |pages=847–53 |year=2008 |pmid=18343972 |doi=10.1007/s00268-008-9513-0 |url= |issn=}}</ref>. Symptom resolution may take one to six months after the procedure. | ||
== Indications == | === 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> | 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 | * Unilateral adrenal hyperplasia | ||
Revision as of 01:14, 21 July 2017
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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. Retroperitoneoscopic removal of adrenal glands in patients with primary hyperaldosteronism (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.[1]. Symptom resolution may take one to six months after the procedure.
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
- ↑ Walz MK, Gwosdz R, Levin SL, Alesina PF, Suttorp AC, Metz KA, Wenger FA, Petersenn S, Mann K, Schmid KW (2008). "Retroperitoneoscopic adrenalectomy in Conn's syndrome caused by adrenal adenomas or nodular hyperplasia". World J Surg. 32 (5): 847–53. doi:10.1007/s00268-008-9513-0. PMID 18343972.
- ↑ 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.