Results of adrenal surgery in patients with hypertension, aldosterone excess, and low plasma renin concentration.

Ferriss, J. B.; Brown, J. J.; Fraser, Robert; Haywood, E. F.; Davies, David; Kay, A. W.; Lever, A. F.; Robertson, J. I. S.; Owen, Katharine R.; Peart, W. S.

doi:10.1136/bmj.1.5950.135

Cited by 78 publications

(24 citation statements)

References 16 publications

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“…At variance with other studies reporting the preoperative use of spironolactone as MR antagonist (32,33) this compound was not used in any of our patients because of its known anti-androgenic side effects. Therefore, canrenone or potassium canrenoate was preferred.…”

Section: Discussionmentioning

confidence: 59%

Small tumor size as favorable prognostic factor after adrenalectomy in Conn's adenoma

Giacchetti¹,

Ronconi²,

Rilli³

et al. 2009

European Journal of Endocrinology

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Objective: Primary aldosteronism (PA) due to aldosterone-producing adenoma (APA) is the most common curable form of secondary hypertension. Design: In order to evaluate blood pressure outcome after adrenalectomy for APA and to identify new favorable prognostic factors, data from 42 consecutive APA patients who underwent adrenalectomy were collected from 2005 to 2007. Methods: Renin-angiotensin-aldosterone system (upright and postsaline infusion test), serum and urinary electrolytes, office and ambulatory blood pressure monitoring were evaluated at baseline and after a follow-up of 2.7G2.2 years. Drug history and adenoma size at morphological evaluation were also collected. Results: Multiple regression analysis showed that, before surgery, patients with a small adenoma (diameter !20 mm) displayed higher postsaline aldosterone values (PZ0.0001), and lower serum potassium levels (PZ0.020), than patients with adenoma O20 mm. Before surgery, mineralocorticoid receptor (MR) antagonists were used in patients with small APA in greater percentage than patients with bigger adenomas (64 vs 30% respectively, PZ0.037). At follow-up, blood pressure normalized in 63% of the subjects. Recovered patients had a shorter duration of hypertension (PZ0.038), and a smaller adenoma size (PZ0.035). Receiver operating characteristic curves showed that a duration of hypertension %6 years and an APA size !20 mm were the best predictors of blood pressure normalization. Patients with APA !20 mm showed the complete restoration of blood pressure circadian rhythm. Conclusions: The presence of APA !20 mm, duration of hypertension equal or less than 6 years, and preoperative MR antagonists use are favorable prognostic factors for hypertension recovery after adrenalectomy.

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Section: Discussionmentioning

confidence: 59%

Small tumor size as favorable prognostic factor after adrenalectomy in Conn's adenoma

Giacchetti¹,

Ronconi²,

Rilli³

et al. 2009

European Journal of Endocrinology

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“…This suggests that the prevalence of PA in Tayside is as high as that in the Australian hypertensive population, and this is likely to be true elsewhere, with obvious important implications for hypertension management. Journal of Human Hypertension (2000) 14, 311-315 diagnosis of PA due to an adrenal adenoma may offer a cure or improved blood pressure control when surgically treated, 9 and in cases due to bilateral adrenal hyperplasia, spironolactone offers the best medical treatment option if tolerated, 10 with amiloride being an alternative medication. With the likely introduction of eplerenone, which is a new generation of specific aldosterone receptor antagonist lacking the side effect profile of spironolactone, it is more urgent that hypertensive patients with nonadenomatous PA should be identified.…”

Section: Introductionmentioning

confidence: 99%

High prevalence of primary aldosteronism in the Tayside hypertension clinic population

et al. 2000

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Primary aldosteronism (PA) was thought to be rare but recent evidence from Australia suggests that it may be more common. As this has important implications in terms of hypertension management, we undertook to screen for this treatable condition in our hypertension clinic. We obtained blood samples in sequential patients referred for assessment in our hypertension clinic in Tayside for plasma renin activity (PRA) and aldosterone. The aldosterone to PRA ratio (ARR) was used as an initial screening test to identify potential patients with PA. Those patients with an elevated ratio (у750) were admitted for the salt loading and fludrocortisone suppression test. These patients also underwent adrenal CT scanning, and in selected patients, adrenal scintigraphy. Between May 1995 and January 1997 (21 months), we screened a total of 495 patients. ARR was available in 465 (93.9%) patients. Out of that number, 77 (16.6%)

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“…8 After confirming the diagnosis of PA, it is fundamental to distinguish between unilateral and bilateral subtypes, because individuals with unilateral forms (mainly aldosterone-producing adenomas [APAs]) can be cured or at least experience significant amelioration of the disease by unilateral laparoscopic adrenalectomy, 1,3,9,10 whereas patients with bilateral adrenal hyperplasia (BAH) are usually treated and benefit from targeted pharmacotherapy with aldosterone antagonists. 1,11 Computed tomography scanning lacks sensitivity and specificity 10,[12][13][14] and should, therefore, be followed by adrenal venous sampling (AVS), which is the only reliable means of differentiating unilateral from bilateral PA and lateralizing APAs preoperatively.…”

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confidence: 99%

Impact of Different Diagnostic Criteria During Adrenal Vein Sampling on Reproducibility of Subtype Diagnosis in Patients With Primary Aldosteronism

et al. 2010

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Abstract-In patients with primary aldosteronism, adrenal vein sampling (AVS) is considered the only reliable technique to distinguish between unilateral and bilateral autonomous production of aldosterone, but agreement is lacking on the best criteria indicating successful cannulation and lateralization. The objective of this study was to assess the impact of differing criteria for the successful cannulation and lateralization on the reproducibility of subtype diagnosis. Sixty-two patients with confirmed primary aldosteronism underwent AVS on 2 separate occasions, because the first was unsatisfactory. We compared the different diagnoses of primary aldosteronism subtype reached using AVS data assessed by permissive (type 1), intermediate (type 2), and strict (type 3) criteria. Although 91.1% of all of the (both first and second) AVSs were "successful" by type 1 criteria (50.8% by type 2 and 33.9% by type 3), in only 35.3% of patients was the diagnosis concordant between the first and second AVS. Type 1 criteria also led to a higher rate of diagnosis of unilateral primary aldosteronism (67.3% of successful procedures) than type 2 (36.5%) or type 3 (26.2%). There was considerable disparity in the diagnosis reached using the 3 different criteria, with concordance in only 32.2%. Using either type 1 or 2 criteria, the minimal adrenal/peripheral vein cortisol ratio necessary to obtain the same diagnosis in the first and second AVS procedures was Ն2.75. In conclusion, permissive criteria for successful cannulation and lateralization on AVS achieve poor diagnostic reproducibility and should be avoided. (Hypertension. 2010;55:667-673.)Key Words: endocrine hypertension Ⅲ primary aldosteronism Ⅲ aldosterone Ⅲ aldosterone-producing adenoma Ⅲ bilateral adrenal hyperplasia P rimary aldosteronism (PA) is currently believed to be the most frequent form of secondary endocrine hypertension, accounting for 5% to 10% of all hypertensive patients.

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Results of adrenal surgery in patients with hypertension, aldosterone excess, and low plasma renin concentration.

Cited by 78 publications

References 16 publications

Small tumor size as favorable prognostic factor after adrenalectomy in Conn's adenoma

Small tumor size as favorable prognostic factor after adrenalectomy in Conn's adenoma

High prevalence of primary aldosteronism in the Tayside hypertension clinic population

Impact of Different Diagnostic Criteria During Adrenal Vein Sampling on Reproducibility of Subtype Diagnosis in Patients With Primary Aldosteronism

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