From the Departments of Endocrinology, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
Department of Surgery, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
QJM. 2017 May 1;110(5):277-281. doi: 10.1093/qjmed/hcw194.
In approximately half of cases of primary aldosteronism (PA), the cause is a surgically-resectable unilateral aldosterone-producing adrenal adenoma. However, long-term data on surgical outcomes are sparse.
We report on clinical outcomes post-adrenalectomy in a cohort of patients with PA who underwent surgery.
Retrospective review of patients treated for PA in a single UK tertiary centre.
Of 120 consecutive patients investigated for PA, 52 (30 male, median age 54, range 30-74) underwent unilateral complete adrenalectomy. Blood pressure, number of antihypertensive medications, and serum potassium were recorded before adrenalectomy, and after a median follow-up period of 50 months (range 7-115). Recumbent renin and aldosterone were measured, in the absence of interfering antihypertensive medication, ≥3months after surgery, to determine if PA had been biochemically cured.
Overall, blood pressure improved from a median (range) 160/95 mmHg (120/80-250/150) pre-operatively to 130/80 mmHg (110/70-160/93), P < 0.0001. 24/52 patients (46.2%) had cured hypertension, with a normal blood pressure post-operatively on no medication. 26/52 (50%) had improved hypertension. 2/52 patients (3.8%) showed no improvement in blood pressure post-operatively. Median (range) serum potassium level increased from 3.2 (2.3-4.7) mmol/l pre-operatively to 4.4 mmol/l (3.3-5.3) post-operatively, P < 0.0001). Median (range) number of antihypertensive medications used fell from 3 (0-6) pre- to 1 post-operatively (range 0-4), P < 0.0001.
Unilateral adrenalectomy provides excellent long-term improvements in blood pressure control, polypharmacy and hypokalaemia in patients with lateralizing PA. These data may help inform discussions with patients contemplating surgery.
在原发性醛固酮增多症（PA）的大约一半病例中，病因是可通过手术切除的单侧醛固酮分泌肾上腺腺瘤。然而，关于手术结果的长期数据却很少。
我们报告了在接受单侧肾上腺切除术的 PA 患者队列中的临床结果。
对英国一家三级中心治疗的 PA 患者进行回顾性研究。
对 120 例连续接受 PA 检查的患者进行回顾性分析，其中 52 例（30 例男性，中位年龄 54 岁，范围 30-74 岁）接受了单侧完全肾上腺切除术。在术前和中位随访时间为 50 个月（范围 7-115 个月）后记录血压、降压药物数量和血清钾。在没有干扰降压药物的情况下，术后中位随访 3 个月以上测量卧位肾素和醛固酮，以确定 PA 是否生化治愈。
总体而言，血压从术前的中位数（范围）160/95mmHg（120/80-250/150）降至 130/80mmHg（110/70-160/93），P<0.0001。24/52 例（46.2%）患者高血压得到治愈，术后无需药物即可维持正常血压。26/52 例（50%）患者高血压得到改善。2/52 例（3.8%）患者术后血压无改善。术前血清钾中位数（范围）从 3.2（2.3-4.7）mmol/L升至术后 4.4mmol/L（3.3-5.3），P<0.0001）。术前（0-6）和术后（0-4）中位数（范围）降压药物数量从 3 种减少至 1 种（范围 0-4），P<0.0001。
在存在侧化 PA 的患者中，单侧肾上腺切除术可长期显著改善血压控制、多药治疗和低钾血症。这些数据可能有助于为考虑手术的患者提供信息。
