Anesthesia and laparoscopic adrenalectomy for primary aldosteronism.

Adrenalectomy is the curative treatment of primary aldosteronism or Conn's syndrome. Laparoscopic adrenalectomy, a new method, should result in less pain and shorter hospitalization. We reported 25 patients who received anesthesia and laparoscopic adrenalectomy from 1995-1999. There were 17 females and 8 males. The mean age was 41.9 years (range 25-59). Ninety-six per cent had hypertension, 76 per cent had weakness of the extremities. When these patients sought medical care, their serum potassium and bicarbonate were 2.4 and 30.9 mEq/l respectively. Before operation, after treatment with spinorolactone, they were 4.3 and 24.4 mEq/l respectively. Associated diseases and cardiovascular abnormalities were reported. General anesthesia was the anesthetic technique of choice. Laparoscopic adrenalectomy was described in detail. Sixteen patients had adenomas on the left adrenal gland, 9 were on the right. Twenty-four patients had unilateral adrenalectomy, one had enucleation of the tumor. The size of the adenoma was 1.8 cm (range 1-3). There was no morbidity or mortality. All patients were discharged on the third postoperative day.

Primary aldosteronism.

We studied retrospectively 25 cases of primary aldosteronism which had presented at Siriraj Hospital between 1980 and 1993. There were 10 males and 15 females (M:F = 1:1.5), aged from 26-64 years old (average 43 years). The duration of the illness varied from 1 to 20 years (5.64 + 4.48 years). The presenting symptoms were proximal muscle weakness of extremities, 16 cases (64%) ; headache, 9 cases (36%) ; unable to stand up after sitting, 6 cases (24%) ; exertional dyspnea, 5 cases (20%) ; nocturia, 3 cases (12%) ; orthopnea, 1 case (4%) and arrhythmia with fainting, 1 case (4%). The patients with cardiac arrhythmia had a very low level of serum potassium (1.8 mEq/L). Physical examination revealed left ventricular hypertrophy in only 5 cases (20%). There was very little change in the ocular fundi but every case had high blood pressure ranging from 150-240/100-150 mm.Hg. (average 176.67 + 24.50/114.26 + 12.46 mm.Hg). Serum sodium varied from 134-152 mEq/L (average 145.58 + 4.42 mEq/L). Serum potassium was 1.3-3.3 mEq/L (average 2.11 + 0.48 mEq/L). Serum bicarbonate was high, 25-50 mEq/L (average 31.84 + 5.81 mEq/L). No significant change in BUN and creatinine was observed. Potassium in a twenty four hours urine specimen was 11.04-78 mEq/day (average 40.84 + 5.81 mEq/day). To confirm the diagnosis and localize and lesion a CT scan of the adrenal gland was performed and tumor masses were found on the right, 9 cases (36%) and on the left, 16 cases (64%). Surgical removal was carried out in only 20 cases. Golden yellowish tumours were excised varying in size from 1*0.3 – 3.5*2 cms. Pathological studies revealed 18 cases (90%) of adenoma and 2 cases (10%) of hyperplasia. Of those with adenoma, blood pressure in 13 cases (72.22%) returned to normal after surgery but the other 5 cases (27.78%) still had high blood pressures still needed antihypertensive treatment. Serum potassium returned to normal in both groups of patients, adenoma and hyperplasia.