Selection of patients and operative approach in primary aldosteronism.

Annals of Surgery
T K HuntE G Biglieri

Abstract

A system for discriminating between adrenal adenoma and hyperplasia based on the levels of aldosterone production, plasma renin concentration, severity of electrolyte disturbances, plasma aldosterone patterns during recumbency and after assuming erect posture, and 131I-19-iodocholesterol scan has been developed. Indicated for operation are patients with adenomas whose elevated blood pressure cannot be continuously controlled with usual doses of medication and patients with documented deterioration of target organ function. Adrenalectomy has been performed 83 times in 81 patients with a diagnosis of primary hyperaldosteronism. Results of excision of adrenal adenomas have been excellent with significant lowering of blood pressure in all cases and cure of hypertension in over 60%. Results of total or subtotal adrenalectomy for hyperplasia have been poor with almost all patients still requiring medication for hypertension. Adenomas have always been unilateral, and usually can be localized so that unilateral exploration is curative. Therefore, we have tried to distinguish preoperatively between adenoma and hyperplasia. Anterior transperitoneal adrenalectomy has been effective with few complications, and no postoperative hypercortiso...Continue Reading

References

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Citations

Jan 1, 1990·Seminars in Surgical Oncology·R C Merrell
Nov 1, 1982·World Journal of Surgery·P O GranbergP E Lins
Jan 1, 1988·International Urology and Nephrology·T NakadaY Mizumura
Sep 1, 1982·American Journal of Surgery·C F RussellD M Ilstrup
Jul 1, 1986·American Journal of Surgery·R C LimT K Hunt
Jul 12, 1984·The New England Journal of Medicine·R M CareyF M Bumpus
Jan 1, 1980·Annals of Surgery·S P AudaJ R Gill
Feb 1, 1980·The Journal of Clinical Investigation·O B HollandH Braunstein
Jan 1, 1980·Pharmacology & Therapeutics·B A Scoggins, J P Coghlan
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Jul 15, 1999·Anaesthesia·S M WinshipJ M Hunter
Dec 1, 1984·The British Journal of Surgery·T K HuntE G Biglieri
Jan 1, 1980·Critical Reviews in Clinical Laboratory Sciences·M D Burke
Jul 28, 2009·Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists·Martha A ZeigerUNKNOWN American Association of Endocrine Surgeons
Feb 1, 1983·The Journal of Urology·A Ganguly, J P Donohue
Jun 26, 2001·Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists·L C Haenel, K L Hermayer

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