Department of Internal Medicine, Hôpital Tenon, 4 Rue de la Chine, 75020 Paris, France.
Horm Metab Res. 2012 Mar;44(3):221-7. doi: 10.1055/s-0031-1299681. Epub 2012 Jan 13.
Aldosterone hypersecretion in primary aldosteronism is unilateral (aldosterone producing adenoma and primary unilateral hyperplasia) or bilateral (idiopathic adrenal hyperplasia). Laparoscopic adrenalectomy is nowadays the preferred approach to treat patients with unilateral primary aldosteronism. We review the outcomes of this intervention in recently published series. Laparoscopic adrenalectomy has a morbidity of 5-14%, mortality below 1%, and a mean hospital stay around 3 days. It generally results in the normalization of aldosterone secretion and in a large decrease of blood pressure and antihypertensive medication, but normotension without treatment is only achieved in 42% of all cases. Normotension following adrenalectomy is more likely in young and lean women with recent low grade hypertension than in obese men with long-standing high grade hypertension or a family history of hypertension. However, individual prediction of the blood pressure outcome is not accurate and predictors of hypertension cure should not be used to select patients for surgery. Age, associated health conditions and preferences of the patient are more relevant to this end.
原发性醛固酮增多症中的醛固酮分泌过多是单侧的（醛固酮产生腺瘤和原发性单侧增生）或双侧的（特发性肾上腺增生）。如今，腹腔镜肾上腺切除术是治疗单侧原发性醛固酮增多症患者的首选方法。我们回顾了最近发表的系列研究中该干预措施的结果。腹腔镜肾上腺切除术的发病率为 5-14%，死亡率低于 1%，平均住院时间约为 3 天。它通常可使醛固酮分泌正常，并使血压和降压药物大量减少，但所有病例中只有 42%的患者血压正常而无需治疗。在年轻、瘦的近期低级别高血压女性中，手术后血压正常的可能性高于肥胖、长期患有高级别高血压或有高血压家族史的男性。然而，血压结果的个体预测并不准确，不应使用高血压治愈的预测因素来选择手术患者。年龄、相关健康状况和患者的偏好对这方面更为重要。
