Hartmann Igor, Grepl Michal, Vidlar Ales, Smakal Oldrich, Vaclavik Jan, Frysak Zdenek, Dolezel Martin, Student Vladimir
Department of Urology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2014 Dec;158(4):583-90. doi: 10.5507/bp.2014.059. Epub 2014 Dec 2.
Primary hyperaldosteronism is a common cause of secondary hypertension. In patients with proven unilateral overproduction of aldosterone adrenalectomy can cure hyperaldosteronism with high probability and a positive effect on hypertension. The aim of the study was to determine the effects of unilateral adrenalectomy on blood pressure and laboratory parameters. The secondary objective was to identify parameters that would allow the prediction of hypertension cure.
We performed a cross-sectional analysis of the data of patients who underwent unilateral adrenalectomy for primary aldosteronism at the Department of Urology of University Hospital Olomouc in the years 2000-2011. We assesed the preoperative clinical conditions of patients, the results of biochemical and radiological examinations, course of the surgery and post-operative course including laboratory and clinical parameters during the 12 months postoperatively.
62 patients underwent adrenalectomy for primary aldosteronism in this period. Four patients were excluded from the study due to surprising histology (myelolipoma in 2, carcinoma in 2), seven patients had incomplete postoperative data. The statistical analysis therefore included 51 patients, of which 57% were females. CT or MRI was performed in all patients; 63% patients underwent superselective catheterization of adrenal veins (AVS). Adrenalectomy was performed in all cases laparoscopically. Histology most often showed adrenal hyperplasia (59%), adenoma was detected in 37% and adenoma on the basis of micronodular hyperplasia in 4%. Twelve months after surgery the antihypertensive drugs were discontinued in 17/51 (33%) and the number or dose of antihypertensive drugs was reduced in 25/51 (49%). Normokalemia and normalisation of the aldosterone-renin ratio (ARR) was detected in 92% and 84% of the patients. Performing AVS did not statistically significantly influence the rate of blood pressure control or normalization of ARR, which is probably due to small study size. This study demonstrated a better effect of surgery on blood pressure in younger patients.
Unilateral adrenalectomy had a positive effect in 82% of the patients operated for primary aldosteronism and lead to either blood pressure normalization or reduction of the antihypertensive medication.
原发性醛固酮增多症是继发性高血压的常见病因。对于已证实存在单侧醛固酮分泌过多的患者，肾上腺切除术很有可能治愈醛固酮增多症，并对高血压产生积极影响。本研究的目的是确定单侧肾上腺切除术对血压和实验室参数的影响。次要目的是识别能够预测高血压治愈情况的参数。
我们对2000年至2011年在奥洛穆茨大学医院泌尿外科接受原发性醛固酮增多症单侧肾上腺切除术的患者数据进行了横断面分析。我们评估了患者的术前临床状况、生化和放射学检查结果、手术过程以及术后过程，包括术后12个月内的实验室和临床参数。
在此期间，62例患者因原发性醛固酮增多症接受了肾上腺切除术。4例患者因组织学结果意外（2例为髓样脂肪瘤，2例为癌）被排除在研究之外，7例患者术后数据不完整。因此，统计分析纳入了51例患者，其中57%为女性。所有患者均进行了CT或MRI检查；63%的患者接受了肾上腺静脉超选择性插管（AVS）。所有病例均通过腹腔镜进行肾上腺切除术。组织学检查最常见的结果是肾上腺增生（59%），37%检测到腺瘤，4%为基于微结节增生的腺瘤。术后12个月，17/51（33%）的患者停用了降压药物，25/51（49%）的患者降压药物数量或剂量减少。92%的患者血钾正常，醛固酮-肾素比值（ARR）正常化的患者为84%。进行AVS对血压控制率或ARR正常化没有统计学上的显著影响，这可能是由于研究规模较小。本研究表明手术对年轻患者的血压影响更好。
单侧肾上腺切除术对82%接受原发性醛固酮增多症手术的患者有积极影响，可使血压正常化或减少降压药物用量。
