Rizek Philippe, Gorecki Piotr, Lindenmayer Aristid, Moktan Sabita
Department of Surgery, New York Methodist Hospital, Brooklyn, New York 11215, USA.
JSLS. 2011 Jan-Mar;15(1):100-4. doi: 10.4293/108680811X13071180407230.
Primary aldosteronism affects 5% to 13% of patients with hypertension. Idiopathic bilateral hyperplasia (IHA) and unilateral aldosterone-producing adenoma (APA) are the most common types of primary aldosteronism. Bilateral APA is a very rare entity with only a few reports in the literature. We present the case of a patient with metachronous bilateral APA treated with metachronous bilateral total and near total adrenalectomy.
A 66-year-old female was evaluated for hypokalemia and hypertension refractory to medical therapy 2 years after laparoscopic adrenalectomy for right APA. Follow-up abdominal CT scan revealed a new 1.1-cm left adrenal mass. The patient underwent a laparoscopic near total adrenalectomy for her new left adrenal mass. Pathology examination revealed a new APA. The operation and the patient's postoperative course were uneventful. Potassium levels were normalized and her hypertension became well controlled.
APA can present metachronously months to years after adrenalectomy for APA in the contralateral adrenal gland. Laparoscopic adrenalectomy remains the approach of choice for this pathology.
原发性醛固酮增多症在高血压患者中占比5%至13%。特发性双侧肾上腺增生（IHA）和单侧醛固酮瘤（APA）是原发性醛固酮增多症最常见的类型。双侧APA是一种非常罕见的情况，文献中仅有少数报道。我们报告一例经分期双侧肾上腺全切及近全切术治疗的异时性双侧APA患者的病例。
一名66岁女性，因右侧APA行腹腔镜肾上腺切除术后2年，因低钾血症和药物治疗无效的高血压前来就诊。随访腹部CT扫描发现左侧肾上腺有一个新的1.1厘米肿块。患者因新出现的左侧肾上腺肿块接受了腹腔镜近全肾上腺切除术。病理检查显示为新的APA。手术及患者术后过程顺利。血钾水平恢复正常，高血压得到良好控制。
对侧肾上腺切除术后数月至数年，APA可异时出现。腹腔镜肾上腺切除术仍是处理这种病变的首选方法。
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