Abstract
Study about blood pressure variation in the first 24 hours post-operation is limited in patients with adrenal aldosterone-producing adenoma. We aim to evaluate the potential predictors for postoperative hypertension urgency during the first 24 hours after laparoscopic adrenalectomy in patients with aldosterone-producing adenoma. Clinical data of 177 patients with aldosterone-producing adenoma were retrospectively collected from January 2009 to December 2015 and the potential factors that may influence postoperative blood pressure during the first 24 hours after surgery were analyzed. The factors included gender, age, body mass index, preoperative maximum systolic blood pressure, number of antihypertensive medicines, preoperative spironolactone treatment, duration of hypertension, surgical method and approach, adenoma diameter, preoperative proteinuria, estimated glomerular filtration rate, serum potassium and serum aldosterone. Univariate and multivariate regression analyses were used to evaluate the relationship between the above variables and postoperative hypertension urgency. We found that the proportion of patients with a higher systolic blood pressure ≥ 160 mmHg and ≥ 180 mmHg were significantly increased post-operation (both p < 0.001). In multivariate analysis, the maximum systolic blood pressure was an independent predictor of postoperative hypertension urgency, and the cut-off point was 157 mmHg with the sensitivity of 66% and specificity of 82%. Multivariable analysis also showed that preoperative maximum systolic blood pressure and number of antihypertensive medicines were independent risk factors for higher postoperative systolic blood pressure. This study was derived from a high volume adrenal tumor center, and these data may provide a potential tool to guide preoperative counseling.
Highlights
Among the general hypertensive population, primary hyperaldosteronism (PHA) is widely recognized as the most common cause of secondary hypertension [1]
We evaluated the potential predictors for postoperative hypertension urgency during the first 24 hours after laparoscopic adrenalectomy (LA) in patients with aldosterone-producing adenoma (APA)
Laparoscopic partial or total adrenalectomy was successfully performed in all patients, 61.6% and 38.4%, respectively, without conversions to open surgery
Summary
Among the general hypertensive population, primary hyperaldosteronism (PHA) is widely recognized as the most common cause of secondary hypertension [1]. About 3–10% of hypertension patients are diagnosed with PHA [2, 3], with a higher rate of cerebrovascular complications [4]. PHA is caused by the hypersecretion of aldosterone hormone due to adrenocortical lesions, and is associated with clinical manifestations of hypertension and hypokalemia. There are two subtypes of PHA, aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (or bilateral adrenal hyperplasia). Hypokalemia can be successfully cured in most APA patients by surgery, which includes partial adrenalectomy and unilateral total adrenalectomy [6, 7]. There are significant variations in BP during the first 24 hours after surgery, which can cause acute severe cerebrovascular complications, such as stroke, cardiac infarction, etc
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