46: Laparoscopic Partial Adrenalectomy for Aldosterone Producing Adenoma. Experience of a Brazilian Center

It is well known that primary aldosteronism (PA) due to aldosterone-producing adenoma (APA) is a surgically curable secondary hypertension. Thus, the differential diagnosis between unilateral hyperaldosteronemia due to APA and bilateral hyperaldosteronemia due to idiopathic hyperaldosteronism (IHA) is crucial to decide surgical indication for treatment in PA patients. Adrenal venous sampling (AVS) can diagnose the laterality of hypersecretion of aldosterone in those patients, while it is still impossible to differentiate bilateral hypersecretion of bilateral aldosterone-producing adenomas (Blt-APAs) from that of bilateral hyperplasia of IHA. To solve the problem, we try to develop a new method of supper-selective ACTH-stimulated adrenal venous sampling (SS-ACTH-AVS). We performed SS-ACTH-AVS by using a strip-tip type 2.2 Fr micro-catheter (Koshin Medical Inc. Japan). Adrenal effluents were sampled super-selectively at the central veins and at one or two tributaries of adrenal veins in each gland. We would like to emphasize that SS-ACTH-AVS can precisely analyze the situation of hyperfunction of steroidogenesis in each side of adrenals as well as in some tiny lesions inside the adrenal cortex which are not visible in the CT images. Moreover, we can differentiate Blt-APAs from IHA, and postulate the decision of surgical treatment, such as partial adrenalectomy. Thus, we should perform SS-ACTH-AVS especially in the case demonstrating the existence of bilateral adrenal lesions such as unilateral and bilateral tumors, or even no tumor in both sides in the patients with PA.

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Retroperitoneoscopic partial adrenalectomy for aldosterone-producing adenoma using an ultrasonically activated scalpel

BJU International ◽

10.1046/j.1464-410x.1998.00708.x ◽

1998 ◽

Vol 82 (1) ◽

pp. 138-139 ◽

Cited By ~ 12

Author(s):

Suzuki ◽

Sugiyama ◽

Saisu ◽

Ushiyama ◽

Fujita

Keyword(s):

Partial Adrenalectomy ◽

Ultrasonically Activated Scalpel ◽

Aldosterone Producing Adenoma

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Precise Mapping of Intra-Adrenal Aldosterone Activities Provides a Novel Surgical Strategy for Primary Aldosteronism

Hypertension ◽

10.1161/hypertensionaha.119.14341 ◽

2020 ◽

Vol 76 (3) ◽

pp. 976-984 ◽

Cited By ~ 2

Author(s):

Takumi Kitamoto ◽

Kanako Kiriyama Kitamoto ◽

Masao Omura ◽

Tomoko Takiguchi ◽

Yuya Tsurutani ◽

...

Keyword(s):

Computed Tomography ◽

Primary Aldosteronism ◽

Clinical Success ◽

Surgical Strategy ◽

Computed Tomography Imaging ◽

Partial Adrenalectomy ◽

Tomography Imaging ◽

Bilateral Disease ◽

Precise Mapping ◽

Aldosterone Producing Adenoma

Segmental selective adrenal venous sampling (sAVS) elucidates an intraadrenal aldosterone activity map (IAMap), which allows us to design a novel surgical treatment strategy for patients with primary aldosteronism. We evaluated the usefulness of sAVS by analyzing 278 patients with whom we had prospectively used IAMap using the criteria of sAVS for surgical indication between 2009 and 2015. We evaluated its diagnostic accuracy using pathological and postsurgical biochemical and clinical outcomes. One hundred twenty and 158 patients were diagnosed with unilateral and bilateral disease, respectively, through sAVS. The concordance of lateralization diagnosis with computed tomography imaging was 66.6%. Among the unilateral patients, we performed partial adrenalectomy in 68 patients whose IAMap showed focal aldosterone hypersecretion from computed tomography-detectable tumor in the affected adrenal gland. All of them achieved complete biochemical success 1 year after surgery. Furthermore, 25 of 158 bilateral disease patients underwent surgical resection because they were preoperatively diagnosed as bilateral aldosterone-producing adenomas by IAMap. These cases showed complete or partial biochemical success (28.0% and 72.0%, respectively); 36.0% showed complete clinical success. Pathological studies demonstrated that all 145 resected specimens possessed aldosterone-producing adenoma or multiple nodules (132 and 13 cases, respectively), and none showed diffuse hyperplasia. IAMap accurately diagnosed both bilateral and unilateral aldosterone-producing adenomas and diffuse hyperplasia before surgery. sAVS allows a novel surgical strategy for selected PA patients with favorable outcomes.

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Evaluation of Cortisol Production in Aldosterone-Producing Adenoma

Hormone and Metabolic Research ◽

10.1055/s-0043-119878 ◽

2017 ◽

Vol 49 (11) ◽

pp. 847-853 ◽

Cited By ~ 4

Author(s):

Kosuke Inoue ◽

Yuto Yamazaki ◽

Yuya Tsurutani ◽

Sachiko Suematsu ◽

Chiho Sugisawa ◽

...

Keyword(s):

Tumour Size ◽

Serum Cortisol ◽

Dexamethasone Suppression Test ◽

Subclinical Hypercortisolism ◽

Partial Adrenalectomy ◽

Significant Difference ◽

Rosai Hospital ◽

Suppression Test ◽

Aldosterone Producing Adenoma ◽

Dexamethasone Suppression

AbstractAldosterone-producing adenoma (APA) is sometimes accompanied with subclinical hypercortisolism. We investigated the ability of cortisol production in APA, both clinically and pathologically. A retrospective cohort study was conducted at Yokohama Rosai Hospital from 2009 to 2016. Thirty patients with APA and serum cortisol levels during the 1 mg dexamethasone suppression test (F-DST)<3.0 μg/dl were included. We evaluated the 1) difference between pre-adrenalectomy F-DST (pre-F-DST) and post-adrenalectomy F-DST (ΔF-DST), 2) correlation between ∆F-DST and pre-F-DST, tumour size determined by CT, and type of adrenalectomy (total or partial), and 3) relationship between the ratio of F-DST divided by tumour size (ΔF-DST/pre-F-DST/mm) and immunoreactivity of CYP17A1, CYP11B1, and CYP11B2. The median [interquartile range] age was 48 [38–58] years. We found a significant decrease in F-DST after adrenalectomy [before: 1.4 (1.1–1.8); after: 0.9 (0.6–1.2); p<0.001]. Additionally, a significant correlation was found for ΔF-DST and both pre-F-DST (Spearman, ρ=–0.68, p<0.001) and tumour size (ρ=–0.51, p 0.005). No significant difference was found in ΔF-DST between total and partial adrenalectomy. CYP17A1 and CYP11B1 were positive in 21 (100%) and 17 (81%) adenomas, respectively. CYP17A1 immunoreactivity in the tumour was significantly related with ΔF-DST/pre-F-DST/mm (p 0.049). F-DST significantly decreased after adrenalectomy, and most of the adenomas were immunohistochemically positive for CYP17A1 and CYP11B1 as well as CYP11B2. We should consider the possibility of autonomous cortisol production as well as hyperaldosteronism in the evaluation and treatment of APA patients.

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