The Current Status of Minimally Invasive Adrenalectomy for Aldosterone Producing Adenoma: Controversial Issues, and Realistic Expectations of Clinical Cure

Pachter Hersch Leon; Arthurs Likolani; Sant Vivek; Underwood Hunter; Kulkarni Kopel; Parikh Manish; Agrawal Nidhi; Suh Insoo; DiMaggio Charles

doi:10.16956/jes.2023.23.2.27

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저자정보: Pachter Hersch Leon (Department of Surgery New York University Grossman School of Medicine New York NY USA.) Arthurs Likolani (Department of Surgery New York University Grossman School of Medicine New York NY USA.) Sant Vivek (Department of Surgery New York University Grossman School of Medicine New York NY USA.Department of Surgery UCLA School of Medicine Los Angeles CA USA.) Underwood Hunter (Department of Surgery New York University Grossman School of Medicine New York NY USA.Department of Surgery University of Michigan Medical School Ann Arbor MI USA.) Kulkarni Kopel (Department of Surgery New York University Grossman School of Medicine New York NY USA.) Parikh Manish (Department of Surgery New York University Grossman School of Medicine New York NY USA.) Agrawal Nidhi (Department of Surgery New York University Grossman School of Medicine New York NY USA.) Suh Insoo (Department of Surgery New York University Grossman School of Medicine New York NY USA.) DiMaggio Charles (Department of Surgery New York University Grossman School of Medicine New York NY USA.)

저널정보: 대한갑상선-내분비외과학회 The Journal of Endocrine Surgery The Journal of Endocrine Surgery 제23권 제2호

발행연도: 2023.6

수록면: 27 - 39 (13page)

DOI: 10.16956/jes.2023.23.2.27

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Purpose: Minimally invasive adrenalectomy is the standard of care for primary lateralized aldosteronism. Controversy related to clinical cure rates, prediction scores, and the role of adrenal vein sampling (AVS) for lateralization abound. Methods: Retrospective analysis of 53 consecutive adrenalectomy patients from 2013–2021, consisting of demographics, descriptive epidemiology, statistical comparison of pre- and post-adrenalectomy blood pressure, anti-hypertensive medications, plasma aldosterone and renin activity values, comparison of predictive scores, concordance of AVS for lateralization with cross-sectional imaging. Results: Forty-seven (89%) had a beneficial outcomes—19 (36%) achieving both biochemical/clinical cure, 28 (53%) clinically improved. The Utsumi score was superior to the aldosteronoma resolution score (ARS) in discriminating likelihood of cure, particularly in patients <40 years old. Sixteen patients (30%) with pathologic proven hyperplasia, had lower rates of cure or improvement. Forty-seven patients (89%) underwent both cross-sectional imaging and AVS; of those, 45/47 (96%) had concordant lateralization. In a broader cohort of 119 patients at our institution AVS, concordance rates decreased (63%). Conclusion: Adrenalectomy for primary aldosteronism leads to clinical improvement in most, but a far lower fraction achieve full clinical cure of hypertension. Proper expectations of adrenalectomy, must incorporate the Utility of predictive scores, and the significance of any form of unilateral hyperplasia. AVS is broadly nonconcordant with cross-sectional imaging in 33%, but in carefully selected patients can be highly concordant raising the possibility of selective bypassing of AVS in in those <40 years old

#Hyperaldosteronism #Aldosteronism #Adrenalectomy #Hypertension #Nomograms

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