PD1-02 LAPAROSCOPIC PARTIAL ADRENALECTOMY FOR ALDOSTERONE PRODUCING ADENOMA DIAGNOSED BY SUPER-SELECTIVE ACTH-STIMULATED ADRENAL VENOUS SAMPLING

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You have accessJournal of UrologyAdrenal1 Apr 2014PD1-02 LAPAROSCOPIC PARTIAL ADRENALECTOMY FOR ALDOSTERONE PRODUCING ADENOMA DIAGNOSED BY SUPER-SELECTIVE ACTH-STIMULATED ADRENAL VENOUS SAMPLING Atsushi Okato, Shuhei Kamada, Kazuyoshi Nozumi, Kanetaka Miyazaki, Atsushi Inoue, Hiroki Kitoh, Maki Nagata, Jun Saito, Masao Omura, Tetsuo Nishikawa, Seishi Matsui, and Kohzoh Makita Atsushi OkatoAtsushi Okato More articles by this author , Shuhei KamadaShuhei Kamada More articles by this author , Kazuyoshi NozumiKazuyoshi Nozumi More articles by this author , Kanetaka MiyazakiKanetaka Miyazaki More articles by this author , Atsushi InoueAtsushi Inoue More articles by this author , Hiroki KitohHiroki Kitoh More articles by this author , Maki NagataMaki Nagata More articles by this author , Jun SaitoJun Saito More articles by this author , Masao OmuraMasao Omura More articles by this author , Tetsuo NishikawaTetsuo Nishikawa More articles by this author , Seishi MatsuiSeishi Matsui More articles by this author , and Kohzoh MakitaKohzoh Makita More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.121AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Primary aldosteronism (PA) is a disease in which adrenal glands produce aldosterone autonomously. Adrenal venous sampling has been performed to decide treatment policy. Laparoscopic total adrenalectomy has become a standard method for treatment of unilateral PA. It is controversial whether laparoscopic partial adrenalectomy in patients with aldosterone producing adenoma (APA) is appropriate treatment or not because PA is known to be frequently caused by multiple adrenocortical macronodules or micronodules. The aim of this study was to verify the effectiveness of laparoscopic partial aderenalectomy for APA diagnosed by super-selective ACTH-stimulating adrenal venous sampling (SS-ACTH-AVS). This is a new method for localizing culprit lesion of hormone overproduction by using a micro-catheter. METHODS A total of 173 patients with unilateral PA were laparoscopically treated at our institution from April 2008 to March 2013. The tumors of 59 patients were identified as unilateral APA by SS-ACTH-AVS. We conducted study with 33 patients who had undergone laparoscopic partial adrenalectomy. 26 patients were performed laparoscopic total adrenalectomy because of location of tumors and perioperative adrenal central vein damage. Preoperative and postoperative data, including clinical data and biochemical variables were evaluated. RESULTS No conversion to open surgery was needed and no major complications developed. In all of partial adrenalectomy group, complete removal of tumor was pathologically confirmed. At the 6 months after surgery, hypertension resolved without the aid of antihypertensive medication in 73.3% of patients. This result is significantly better therapeutic than total adrenalectomy group. As of one year after surgery, we could follow up 19 patients and their normalization of hormone was biochemically proved. CONCLUSIONS Significant differences in patient background are family history of hypertension and estimated glomerular filtration and triglyceride. These factors might affect the difference in resolution of hypertension between partial and total adrenalectomy group. A previous report showed that some patients who underwent partial adrenalectomy remained PA postoperatively, however, SS-ACTH-AVS was not performed in this study. Our results show that laparoscopic partial adrenalectomy is effective method for unilateral APA, of which tumor is proved to be causing hyperaldosteronism by SS-ACTH-AVS. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e9-e10 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Atsushi Okato More articles by this author Shuhei Kamada More articles by this author Kazuyoshi Nozumi More articles by this author Kanetaka Miyazaki More articles by this author Atsushi Inoue More articles by this author Hiroki Kitoh More articles by this author Maki Nagata More articles by this author Jun Saito More articles by this author Masao Omura More articles by this author Tetsuo Nishikawa More articles by this author Seishi Matsui More articles by this author Kohzoh Makita More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...