Presented by: fahed atamna MD
samson assuta ashdod university hospital

Introduction

Adrenalectomy is a preferable treatment for adrenal adenoma producing hormone, also calls Conn syndrome. The effort of diagnosis Adrenal adenoma and Primary-Hyperaldosteronism is insufficient and consequently, not enough adrenalectomies performed. In the era of Robotic assisted laparoscopic surgeries, we believe that this approach should be use more often, in-order to avoid multiple medication use and better blood pressure control in those patients.  

This  study aims to evaluate the effectiveness and outcomes of adrenalectomy as a treatment for Conn syndrome.

Materials

A cohort study,  conducted on patients diagnosed with PA who underwent adrenalectomy . Clinical data, including preoperative laboratory results, imaging findings, surgical details, and postoperative outcomes, were collected and analyzed. Patients with suspected pheochromocytoma were excluded from this study. We defined Full success: as clinical and biochemical normalization (normal aldosterone and renin levels, and without medication). Partial success: defined as a decrease in aldosterone levels or the number of medications, and failure: defined as no change.

Results

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From September 2019 to the present, eight patients underwent adrenalectomy for PA indications in our institution, three of whom were female. The median age was 47 years (range: 35-80). Female patients were younger than male patients, 39 vs 61 years, respectively. All patients suffered from refractory hypertension, with elevated aldosterone levels, and suppressed renin levels.

Before surgery, two patients were taking one medication for hypertension, while the remaining patients were taking 2-4 medications. Adrenal venous sampling, required in one patient presented with bilateral adrenal adenoma.

The median adrenal nodule size was 15 mm (range: 8-77 mm).

All patients underwent adrenalectomy using a minimally invasive Robotic and laparoscopic transperitoneal approach, with a standard surgical procedure and minimal blood loss. Transient hemodynamic instability was observed during surgery in one patient and in the postoperative recovery of an additional patient.

Complete success was observed in six patients, two others achieved partial success as their aldosterone levels normalized, and hypertension medication were reduced. One failure was noted in this cohort study.

No post-operative complications, recorded.

Conclusion

The results of this study support the use of adrenalectomy as a viable therapeutic option, for Primary-Hyperaldosteronism. This will require a team work of Nephrology, Anesthesiology, Radiology and Urology to be enable a proper patient selection.      

Funding

none

Lead Authors

orit raz, MD
samson assuta ashdod university hospital

Co-Authors

dor golomb, MD
samson assuta ashdod university hospital

adi leiba, MHA
samson assuta ashdod university hospital

alon aisner, MD
samson assuta ashdod university hospital

alla simanovski, MD
samson assuta ashdod university hospital