Novitsky Yuri W, Kercher Kent W, Rosen Michael J, Cobb William S, Jyothinagaram Sathya, Heniford B Todd
Department of Surgery, Carolinas Medical Center, Charlotte, NC 28203, USA.
Surgery. 2005 Dec;138(6):1009-16; discussion 1016-7. doi: 10.1016/j.surg.2005.09.027.
Nodular adrenal hyperplasia (NAH) may mimic the biochemical characteristics of an aldosterone-producing adenoma. The authors evaluated the outcomes of unilateral laparoscopic adrenalectomy in the setting of lateralizing aldosterone hypersecretion by NAH.
Retrospective review of consecutive patients who underwent a laparoscopic adrenalectomy for primary hyperaldosteronism owing to NAH was performed. Patient demographics, perioperative symptoms, medications, radiographic findings, and serum chemistries were analyzed. Response to operation was classified according to postoperative control of hypertension and hypokalemia as resolved, improved, or refractory.
From January 1999 to October 2004, 15 patients underwent a laparoscopic unilateral adrenalectomy for hyperaldosteronism owing to lateralizing NAH. Nine (60%) patients presented with > or =5 years of hypertension, including 8 (53%) patients with labile or malignant hypertension. Ten (67%) patients had hypokalemia. Abdominal imaging results were normal in 9 (60%) patients. All patients underwent adrenal venous sampling (94% successfully), which revealed an average adjusted aldosterone ratio of 17.6 (range, 1.2 to 75.9). At a mean follow-up of 26 (range, 4 to 58) months, hypertension had resolved in 4 (27%), improved in 8 (53%), and was refractory in 3 (20%) patients. Hypokalemia resolved in all patients. There were no complications, conversions, or mortalities.
This series shows that unilateral adrenalectomy for lateralizing NAH results in eradication of hypokalemia and resolution or significant improvement in hypertension in 80% of patients at long-term follow-up. When lateralization of aldosterone production is noted, laparoscopic adrenalectomy provides significant clinical improvement even in patients with a pathologic diagnosis of NAH.
结节性肾上腺增生（NAH）可能模拟醛固酮瘤的生化特征。作者评估了在NAH导致醛固酮分泌增多且已定位的情况下，单侧腹腔镜肾上腺切除术的效果。
对因NAH接受腹腔镜肾上腺切除术治疗原发性醛固酮增多症的连续患者进行回顾性研究。分析患者的人口统计学资料、围手术期症状、用药情况、影像学检查结果和血清化学指标。根据术后高血压和低钾血症的控制情况，将手术反应分为缓解、改善或难治。
1999年1月至2004年10月，15例患者因定位的NAH接受了腹腔镜单侧肾上腺切除术。9例（60%）患者有≥5年的高血压病史，其中8例（53%）为不稳定或恶性高血压。10例（67%）患者有低钾血症。腹部影像学检查结果在9例（60%）患者中正常。所有患者均接受了肾上腺静脉采血（94%成功），平均校正醛固酮比值为17.6（范围为1.2至75.9）。平均随访26（范围为4至58）个月时，4例（27%）患者的高血压得到缓解，8例（53%）患者有所改善，3例（20%）患者难治。所有患者的低钾血症均得到缓解。无并发症、中转手术或死亡病例。
本系列研究表明，因定位的NAH行单侧肾上腺切除术可使低钾血症消除，且在长期随访中80%的患者高血压得到缓解或显著改善。当发现醛固酮分泌定位时，即使病理诊断为NAH的患者，腹腔镜肾上腺切除术也能带来显著的临床改善。
