Primary hyperaldosteronism surgery
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Primary hyperaldosteronism Microchapters |
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Differentiating Primary Hyperaldosteronism from other Diseases |
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Diagnosis |
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Primary hyperaldosteronism surgery On the Web |
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American Roentgen Ray Society Images of Primary hyperaldosteronism surgery |
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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.