Outpatient laparoscopic adrenalectomy in patients with Conn's syndrome

Edwin, Bjørn; Ræder, I.; Trondsen, Erik; Kaaresen, R.; Buanes, Trond

doi:10.1007/s004640090021

Cited by 49 publications

(34 citation statements)

References 17 publications

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“…In such settings, outpatient laparoscopic adrenalectomy is possible in selected cases: patients under the age of 65 years, tumors of less than 6 cm in diameter, no significant cardiorespiratory disease, first case of the day to be managed in the surgical program, residence less than 30 minutes from the hospital by car, and treatment with no more than three antihypertensive agents. [21][22][23] Patients should be treated with a MRA and potassium supplements to lower BP and to correct hypokalemia before surgery. Preoperative mineralocorticoid receptor blockade for a few weeks before surgery may also decrease the risk of postoperative hypoaldosteronism due to the chronic suppression of aldosterone secretion in the contralateral gland.…”

Section: Unilateral Adrenalectomymentioning

confidence: 99%

Outcomes of Drug-Based and Surgical Treatments for Primary Aldosteronism

Steichen

Lorthioir

Zinzindohoué

et al. 2015

Advances in Chronic Kidney Disease

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Treatments for primary aldosteronism (PA) aim to correct or prevent the deleterious consequences of hyperaldosteronism: hypertension, hypokalemia and direct target organ damage. Patients with unilateral PA considered fit for surgery can undergo laparoscopic adrenalectomy, which significantly decreases blood pressure and medications in most cases, and cures hypertension in about 40%. Mineralocorticoid receptor antagonists (MRA) are used to treat patients with bilateral PA and those with unilateral PA if surgery is not possible or not desired. Spironolactone is more potent than eplerenone, but high doses are poorly tolerated in men. MRA can be replaced or complemented with epithelial sodium channel blockers, such as amiloride. Thiazide diuretics and calcium channel blockers are used when the first-line drugs are insufficient to control blood pressure. Dietary sodium restriction should be implemented in all cases, because the deleterious consequences of hyperaldosteronism are dependent on salt loading. Several studies comparing the results of surgery and MRA have reported no differences in terms of blood pressure, serum potassium concentration or cardiovascular and renal outcomes, although the benefits of treatment tend to be observed sooner with surgery.PA patients display relative glomerular hyperfiltration, which is reversed by specific treatment, revealing chronic kidney disease in 30% of patients. However, further kidney damage is prevented by the treatment of PA. Clinical summary-The goals of treatment are the normalization of serum potassium concentration, blood pressure control and prevention of the direct effects of excess aldosterone on target organs. 3-The non-surgical treatment of PA is based on mineralocorticoid receptor antagonists and dietary sodium restriction.-Epithelial sodium channel blockers are used when mineralocorticoid receptor antagonists are not well tolerated; thiazide diuretics and calcium channel blockers are used when blood pressure control is insufficient with the first-line treatment.-Laparoscopic adrenalectomy is safe and decreases BP and medication requirements in patients with unilateral PA; drug-based treatments are appropriate in cases in which surgery is inappropriate or not desired.

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Section: Unilateral Adrenalectomymentioning

confidence: 99%

Outcomes of Drug-Based and Surgical Treatments for Primary Aldosteronism

Steichen

Lorthioir

Zinzindohoué

et al. 2015

Advances in Chronic Kidney Disease

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“…Edwin et al (10) reported that laparoscopic adrenalectomy with transabdominal lateral flank approach can be safely performed in an outpatient setting, with surgical experience, patient selection and optimal anesthesia, in their case series of 13 patients (11). Lee et al (12) did not observe adrenal insufficiency in 13 patients with bilateral pheochromocytoma who underwent cortex sparing adrenal surgery, with recurrences in only three patients.…”

Section: Case Presentationmentioning

confidence: 99%

Cortical sparing laparoscopic adrenalectomy in a patient with Conn’s syndrome

Yetışır

Salman

Özkardeş

et al. 2013

UCD

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Conn's syndrome, an aldosterone producing adenoma, is a surgically curable cause of primary aldosteronism, classically treated by unilateral adrenalectomy. With the advent of laparoscopic surgery in the recent decade, laparoscopic adrenalectomy is currently accepted as the gold standard of treatment for Conn's syndrome. Cortical sparing adrenalectomy is especially an ideal operation for patients with bilateral pheochromocytoma. This case report describes a successful laparoscopic adrenal cortex sparing surgery on the left side and anesthetic approach in a patient with Conn's syndrome, who had a history of previous right surrenalectomy. Laparoscopic surgery without dividing the central adrenal vein can also be performed successfully in patients with Conn's syndrome.

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“…Currently, laparoscopic adrenalectomy is not advised for primary malignant or larger than 5 cm adrenal tumours. Edwin et al [21] report 13 day-case laparoscopic adrenalectomies for Conn's tumours. Laparoscopic adrenalectomy can be performed through the transperitoneal or retroperitoneal approach.…”

Section: Commentsmentioning

confidence: 99%

Abdominal Ganglioneuromas in Adults

et al. 2003

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Ganglioneuromas are rare tumours of the parasympathetic nervous system. Their definitive diagnosis is made on histological examination. When they arise from the adrenal medulla, their assessment and management are the same as those of other adrenal tumours. We here report 3 cases of ganglioneuromas highlighting important points regarding the radiological assessment, management, decision making and surgical approaches.

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Outpatient laparoscopic adrenalectomy in patients with Conn's syndrome

Abstract: Laparoscopic adrenalectomy can be a fast operation. It is feasible and safe and yields satisfactory results for patients as an outpatient procedure when the necessary surgical experience and optimal anesthesia are both available.

Cited by 49 publications

References 17 publications

Outcomes of Drug-Based and Surgical Treatments for Primary Aldosteronism

Outcomes of Drug-Based and Surgical Treatments for Primary Aldosteronism

Cortical sparing laparoscopic adrenalectomy in a patient with Conn’s syndrome

Abdominal Ganglioneuromas in Adults

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