Pirvu Augustin, Naem Nora, Baguet Jean Philippe, Thony Frédéric, Chabre Olivier, Chaffanjon Philippe
Department of Thoracic, Vascular and Endocrine Surgery, University Hospital Grenoble, Grenoble, France,
World J Surg. 2014 Jul;38(7):1749-54. doi: 10.1007/s00268-014-2461-y.
Primary hyperaldosteronism (PHA) is a cause of secondary arterial hypertension potentially curable by laparoscopic unilateral adrenalectomy. We describe the follow-up of these patients according to their medical or surgical treatment.
We report a retrospective single-center study of 91 patients with PHA from 1998 to 2012. Treatment was guided by computed tomography (CT) scans. Preoperative adrenal vein sampling (AVS) was performed when the CT scan did not show single solitary unilateral nodules on the adrenal glands. During the follow-up, we considered hypertension to be cured in patients with normal blood pressure without antihypertensive medication (AM), and improvement was defined by a decrease in AM.
A total of 28 patients received only AM. Of the 62 patients who underwent a unilateral adrenalectomy, 46 (74 %) had an adrenal adenoma, 14 (22 %) a hyperplasia, and the adrenal gland was normal in two cases. Hypertension was cured in 24 cases (38 %), and 28 patients (45 %) showed improvement with a reduction in AM. Predictive factors for a cure were gender, age, number of preoperative AMs, preoperative arterial systolic blood pressure, and plasma renin activity. All patients who presented with hypokalemia were cured postoperatively. We performed 38 AVS and nine of these patients were operated on based on the AVS findings, with an improvement of 100 % of arterial blood pressure after surgery.
Laparoscopic unilateral adrenalectomy for PHA cured or improved hypertension in 84 % of patients. Preoperative AVS is mandatory for surgical decision making if the CT scan shows bilateral or no lesions associated with PHA.
原发性醛固酮增多症（PHA）是继发性动脉性高血压的一个病因，可通过腹腔镜单侧肾上腺切除术治愈。我们根据这些患者接受的药物或手术治疗方式对其进行随访。
我们报告了一项对1998年至2012年间91例PHA患者的单中心回顾性研究。治疗以计算机断层扫描（CT）为指导。当CT扫描未显示肾上腺上有单个孤立的单侧结节时，进行术前肾上腺静脉采样（AVS）。在随访期间，我们将血压正常且未服用抗高血压药物（AM）的患者视为高血压已治愈，将AM减少定义为病情改善。
共有28例患者仅接受了AM治疗。在62例行单侧肾上腺切除术的患者中，46例（74%）患有肾上腺腺瘤，14例（22%）为增生，2例肾上腺正常。24例（38%）患者的高血压得到治愈，28例（45%）患者病情改善，AM减少。治愈的预测因素包括性别、年龄、术前服用AM的数量、术前动脉收缩压和血浆肾素活性。所有出现低钾血症的患者术后均治愈。我们进行了38次AVS，其中9例患者根据AVS结果接受了手术，术后动脉血压改善率达100%。
腹腔镜单侧肾上腺切除术使84%的PHA患者的高血压得到治愈或改善。如果CT扫描显示双侧或无与PHA相关的病变，术前AVS对于手术决策至关重要。
