Surgical Treatment of Primary Aldosteronism

2022 ◽  
pp. 171-185
Author(s):  
Lawrence Kim ◽  
Juan Camilo Mira
Keyword(s):  
Surgical Treatment ◽  
Primary Aldosteronism

Surgical Treatment of Hypertension — Primary Aldosteronism

1962 ◽  
Vol 266 (4) ◽  
pp. 160-164 ◽  
Author(s):  
Reginald H. Smithwick ◽  
Dera Kinsey ◽  
George P. Whitelaw
Keyword(s):  
Surgical Treatment ◽  
Primary Aldosteronism ◽  
Treatment Of Hypertension

scholarly journals Is it Possible to Extirpate Cardiovascular Events in Primary Aldosteronism after Surgical Treatment

2010 ◽  
Vol 1 ◽  
pp. JCM.S6316 ◽  
Author(s):  
Tetsuo Nishikawa ◽  
Yoko Matsuzawa ◽  
Jun Saito ◽  
Masao Omura
Keyword(s):  
Surgical Treatment ◽  
Primary Aldosteronism ◽  
Secondary Hypertension ◽  
Adrenal Venous Sampling ◽  
Venous Sampling ◽  
Partial Adrenalectomy ◽  
Aldosterone Producing Adenoma ◽  
Idiopathic Hyperaldosteronism ◽  
Micro Catheter ◽  
Indication For Treatment

It is well known that primary aldosteronism (PA) due to aldosterone-producing adenoma (APA) is a surgically curable secondary hypertension. Thus, the differential diagnosis between unilateral hyperaldosteronemia due to APA and bilateral hyperaldosteronemia due to idiopathic hyperaldosteronism (IHA) is crucial to decide surgical indication for treatment in PA patients. Adrenal venous sampling (AVS) can diagnose the laterality of hypersecretion of aldosterone in those patients, while it is still impossible to differentiate bilateral hypersecretion of bilateral aldosterone-producing adenomas (Blt-APAs) from that of bilateral hyperplasia of IHA. To solve the problem, we try to develop a new method of supper-selective ACTH-stimulated adrenal venous sampling (SS-ACTH-AVS). We performed SS-ACTH-AVS by using a strip-tip type 2.2 Fr micro-catheter (Koshin Medical Inc. Japan). Adrenal effluents were sampled super-selectively at the central veins and at one or two tributaries of adrenal veins in each gland. We would like to emphasize that SS-ACTH-AVS can precisely analyze the situation of hyperfunction of steroidogenesis in each side of adrenals as well as in some tiny lesions inside the adrenal cortex which are not visible in the CT images. Moreover, we can differentiate Blt-APAs from IHA, and postulate the decision of surgical treatment, such as partial adrenalectomy. Thus, we should perform SS-ACTH-AVS especially in the case demonstrating the existence of bilateral adrenal lesions such as unilateral and bilateral tumors, or even no tumor in both sides in the patients with PA.

scholarly journals SUN-LB92 The Importance of Early Diagnosis and Treatment of Primary Aldosteronism on the Progression of Chronic Kidney Disease, Compared With Essential Hypertension: A Retrospective Cohort Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Jayoung Lim
Keyword(s):  
Essential Hypertension ◽  
Surgical Treatment ◽  
Primary Aldosteronism ◽  
Medical Center ◽  
Case Detection ◽  
Renal Protection ◽  
Treatment Groups ◽  
Endocrine Hypertension ◽  
Study Support ◽  
Better Than

Abstract <META NAME=“author” CONTENT=“Windows 사용자”>Introduction: Primary aldosteronism(PA) has few clinical phenotypes and features, compared with other endocrine hypertension(HTN). Even though hypokalemia is a typical sign of PA, most of PA reveals normal potassium concentration. For that reason, PA is likely to undetected and underestimated and it may account for larger proportion of total HTN than we expected. However, it has known that PA has higher risk of renal complications than essential hypertension(EH) and has been controversy which treatment between medication and operation is better for renal protection of PA. Methods: We retrospectively reviewed the medial records of patients with PA and EH of a single medical center from January, 2009 to December, 2019. PA patients were divided into medical and surgical treatment groups. EH patients were distinguished from one that satisfied with case detection test, called non-confirmed PA. We excluded cases with other secondary HTN and baseline eGFR < 60 mL/min/1.73m2. Results: Patients with PA(N=66) and patients with EH(N=514) were selected for analysis. Each baseline mean eGFR of patients with PA and EH indicated 91.2 ± 74.5 and 87.1 ± 19.7 mL/min/1.73m2 and statistically insignificant differences(P = 0.1688) as well as baseline SBP(P = 0.5403) and DBP(P = 0.8691). However, in spite of treatment of PA and controlled BP, mean eGFR of PA patients was lower than one of EH patients and its difference was statistically significant showing 66.5 ± 14.2 and 94.6 ± 195.9 mL/min/1.73m2 (P < .0001) at 2~ 5 years, 52.4 ± 17.9 and 77.6 ± 20.6 mL/min/1.73m2 (P < 0.0004) at 6~10 years. Baseline mean eGFR of PA with normokalemia and hypokalemia respectively were 77.7 ± 11.6 and 98.9 ± 92.5 mL/min/1.73m2 (P = 0.0269). Baseline mean eGFR of non-confirmed PA and EH were 82.5 ± 13.2 and 88.4 ± 21.1 mL/min/1.73m2 (P = 0.0240). Although baseline mean eGFR of PA with surgical treatment was better than one with medical treatment, it was reversal after 2~5 years indicating mean eGFR of PA patients treated with operation, 62.9 ± 16.1 mL/min/1.73m2 and one treated with spironolactone, 70.5 ± 12.6 mL/min/1.73m2 (P = 0.0010). Conclusions: This study support PA has worse effects on renal function than EH. PA is frequently unsuspected and undiagnosed because it hardly shows symptoms and signs. Many cases do not reveal main characteristics such as uncontrolled HTN and hypokalemia, so that patients with PA maybe have longstanding exposure to risk of CKD. Therefore it is necessary to do case detection test and rule out PA in initial hypertensive patients. In addition, more longitudinal study and research should be performed to decide personalized and adequate treatments for PA patients.

scholarly journals An experience of surgical treatment for primary aldosteronism associated with chronic renal failure.

2001 ◽  
Vol 62 (6) ◽  
pp. 1518-1521
Author(s):  
Naoto KITAHARA ◽  
Naoyoshi ONODA ◽  
Tetsuro ISHIKAWA ◽  
Akiko TACHIMORI ◽  
Yoshinari OGAWA ◽  
...  
Keyword(s):  
Renal Failure ◽  
Surgical Treatment ◽  
Chronic Renal Failure ◽  
Primary Aldosteronism

Factors Influencing Outcome of Surgical Treatment for Primary Aldosteronism

2003 ◽  
Vol 3 (2) ◽  
pp. 141
Author(s):  
Myung Chul Chang ◽  
Dong-Young Noh ◽  
Yeo-Kyu Youn ◽  
Kuk Jin Choe ◽  
Seung Keun Oh
Keyword(s):  
Surgical Treatment ◽  
Primary Aldosteronism ◽  
Factors Influencing

Diagnosis and surgical treatment of primary aldosteronism in pregnancy: A case report

1995 ◽  
Vol 86 (4) ◽  
pp. 644-645 ◽  
Author(s):  
F BARON ◽  
M SPRAUVE ◽  
J HUDDLESTON ◽  
A FISHER
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Primary Aldosteronism ◽  
In Pregnancy
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