Therapeutic Outcome of Primary Aldosteronism: Adrenalectomy Versus Enucleation of Aldosterone-Producing Adenoma

Abstract

Our followup study of 48 patients with primary aldosteronism concerns the results of 2 different operative methods. After preoperative localization of the unilateral solitary tumor 22 patients underwent unilateral adrenalectomy and 26 underwent enucleation of aldosterone-producing adenoma. Both operative methods improved hypertension, hypokalemia, the low urinary sodium-to-potassium ratio, suppressed plasma renin activity, high plasma aldosterone concentration, high urinary aldosterone excretion and high urinary kallikrein excretion in similar orders of magnitude for 5 years. Levels of plasma cortisol and plasma adrenocorticotropic hormone following respective operations were also identical. Five years postoperatively, ambulation and furosemide administration under low sodium diet stimuli remarkably enhanced plasma renin activity and plasma aldosterone concentration in the aldosterone-producing adenoma enucleation group (p < 0.001), almost similar to that of normal subjects but increment magnitudes were slight (p < 0.05 to < 0.01) in the adrenalectomy group. Preoperatively, angiotensin II infusion failed to increase plasma aldosterone concentration in patients with primary aldosteronism. After respective operations, responses of plasma aldosterone concentration to angiotensin II infusion and of plasma cortisol to adrenocorticotropic hormone administration in the aldosterone-producing adenoma enucleation group were more sensitive than those in the adrenalectomy group. There was no remission of recurrent hyperaldosteronism in either group throughout the study. These results suggest that angiotensin II induces aldosterone release by an activation of tumor uninvolved cortical cells and that the enucleation of aldosterone-producing adenoma is more preferable than unilateral adrenalectomy.

Analysis of mRNA expression for steroidogenic enzymes in the remaining adrenal cortices attached to adrenocortical adenomas.

“…Laparoscopic subtotal adrenalectomy with preservation of functional adrenal tissue has been attempted (12,13). This approach would seem to be successful, although the postoperative long-term follow-up is often inadequate (5,7,14).…”

818 Comparative effectiveness of adrenal sparing radical nephrectomy and non-adrenal sparing radical nephrectomy in clear cell renal cell carcinoma: Observational study of survival outcomes

“…12,21,22 Nakada and colleagues reported that enucleating an aldosterone-producing adenoma is preferable to unilateral adrenalectomy, as the response of plasma cortisol to ACTH administration in patients with an aldosterone-producing adenoma enucleated was more sensitive than in those after adrenalectomy, even 5 years after surgery. 23 In keeping with these findings, Yokoyama and colleagues reported that the reserve of adrenocortical function 2 weeks after surgery was impaired in patients treated by ipsilateral adrenalectomy compared with those after adrenal-sparing RN for RCC.…”

Retroperitoneoscopic Partial Adrenalectomy Using an Endoscopic Stapling Device in Patients with Adrenal Tumor

“…Partial adrenalectomy usually maintains the function of the remnant adrenal tissues in patients with functioning adrenal adenoma [4,7]. According to Nakada et al [4], cortisol secretion to adrenocorticotropic hormone stimulation is more remarkable in the partially adrenalectomized group than in the totally adrenalectomized group.…”

“…With the advent of modern endoscopic surgery [1,2], posterior retroperitoneoscopic adrenalectomy has become a new minimally invasive procedure [3]. In patients with functioning adrenal adenoma, partial adrenalectomy usually preserves the function of the remnant adrenal gland [4,5]. However, endoscopic partial adrenalectomy is not generally performed because it is very difficult to prevent bleeding from the resected area.…”