Adrenal Venous Sampling (AVS) Correlated With Histopathologic Findings as a Predictive Model for Surgical Outcomes Post Unilateral Adrenalectomy for PA: Beyond Laterality

• 발행기관: 대한내분비외과학회
• 저자명: H. Leon Pachter, Likolani Arthurs Kopal Kulkarni, Myles Taffel Manish Parikh Nidhi Agrawal Charles Dimaggio
• 간행물 정보: 『The Koreran journal of Endocrine Surgery』24권4호, 98~107쪽, 전체 10쪽
• 주제분류: 의약학 > 면역학
• 파일형태: PDF
• 발행일자: 2024.12.31

국문 초록

Purpose: Adrenalectomy for primary aldosteronism (PA) lateralized to one gland yields significant biochemical cure rates, but clinical outcomes are less favorable, especially for patients with “non-classic” pathologies like multiple aldosterone producing nodules or hyperplasia. This study investigates why surgical results are poorer in “non-classic” PA, the ability of preoperative imaging to differentiate these, entities, and the existence of preoperative biochemical markers. Methods: The authors retrospectively reviewed 53 consecutive PA patients who underwent laparoscopic adrenalectomy at a tertiary care academic institution. Demographic data were collected and Statistical analyses compared pre- and post-operative blood pressure & antihypertensive medication use. Pathologic and radiographic results were examined by specialists. Results: Radiologically, “classic” and “non-classic” groups could not be distinguished. In the “classic” group, 95% achieved total cure and 57% showed improvement. Conversely, in the “non-classic group,” only 5% were cured while 43% improved. AVS data indicated that adenomas of the “classic” group secreted nearly twice the aldosterone as the “non-classic” group (8,074 vs. 4,423.5, P=0.02). The contralateral gland in the “non-classic” group secreted almost twice the aldosterone compared to the “classic” group though not statistically significant (419 vs. 273.3, P=0.1). Conclusion: Patients with unilateral “non-classic” PA fare worse than those with unilateral “classic” PA after unilateral adrenalectomy. The non-classic variety may represent a form of asymmetrical bilateral hyperplasia. Cross table imaging is incapable of distinguishing between the 2 entities. AVS may identify non-classic unilateral PA and serve to address patient and physician expectations.

목차

INTRODUCTION

MATERIALS AND METHODS

RESULTS

DISCUSSION

CONCLUSION

REFERENCES

키워드

Adrenalectomy Hyperaldosteronism Adrenal gland diseases Adrenocortical hyperfunction Endocrine surgical procedures