Selection of treatment and surgical methods of a patient with primary aldosteronism / 中华内分泌外科杂志

Primary aldosteronism (PA) is a kind of disease caused by excessive aldosterone secretion from the adrenal cortex, the reason of which include bilateral adrenal hyperplasia, aldosteronoma, unilateral adrenal hyperplasia, etc. Surgical treatment is the first choice for unilateral adrenal lesions. In this article, we report a patient who underwent left adrenal surgery but did not achieve the expected results. This case suggests that clinicians need to further improve the level of diagnosis and treatment of primary aldosteronism, especially the surgical methods.

Severe hyperkalemia after aldosteroneoma resection: a case report / 中华泌尿外科杂志

We reviewed the data of an 18-year-old male patient complained of weakness of limbs and hypokalemia for 6 months. CT scan revealed left adrenal adenoma. He was diagnosed as primary aldosteronism(PA). Laboratory tests showed hypokalemia and hyperaldosteronemia. After potassium supplement and blood pressure lowering treatment, laparoscopic resection of the left adrenal adenoma was performed, and severe hyperkalemia occured 2 hours after surgery(maximum serum potassium 7.02 mmol/L). After hyperrisotonic glucose+ insulin(10% glucose 200 ml+ 50% glucose 40 ml+ insulin 8U)+ cation exchange resin(Sodium Polystyrene Sulfonate 20 g) treatment, serum potassium returned to normal range within 12 hours. The plasma aldosterone, blood potassium and blood pressure returned to normal during the 5-month follow-up. According to the experience of this case report, after resection of aldosteronoma, the changes of serum electrolyte should be closely monitored, the occurrence of hyperkalemia should be vigilant.

Two cases of aldosterone-and cortisol-producing adenoma / 中华内分泌外科杂志

More and more cases of aldosterone-and cortisol-producing adenoma (A/CPA) have been reported in recent years.In order to further understand the clinical characteristics of patients with A/CPA,we report 2 cases of A/CPA treated in our hospital,and analyzes them in combination with domestic reports.We recommend that clinicians routinely perform Low Dose Dexamethasone Suppression Test on every primary aldosteronism patient prior to adrenal vein sampling (AVS) or adrenal adenoma surgery to rule out the possibility of Cushing's syndrome so as to avoid the wrong judgment of AVS results and avoid adrenal hypofunction or adrenal crisis after operation.

Prevalence and postoperative changes of metabolic syndrome in patients with adrenocortical adenoma / 中国糖尿病杂志

Objective To investigate changes of metabolic syndrome (MS ) in patients with adrenocortical adenoma (ACA ). Methods Sixty‐five patients with aldosterone producing adenoma (APA) ,43 patients with cortisol‐secreting adenoma (CSA) and 24 patients with nonfunctional adrenal adenoma (NAA) were evaluated. Body Mass Index (BMI) ,blood pressure ,plasma lipid ,fasting and 2 h postprandial plasma glucose ,plasma and urinary aldosterone ,plasma potassium ,basic and upright plasma renin activity (PRA ) ,plasma and urinary cortisol ,plasma ACTH and plasma potassium ACA were examined and compared with those from 53 patients of essential hypertension (EH ) and 58 controls. Adrenalectomy was performed for all the patients with adrenocortical adenoma. The data after operation were compared with those before operation. Results (1) The prevalence of MS was 38.5% ,41.9% , 20.8% ,24.5% and 17.5% in the groups respectively. The prevalence of obesity/overweight was higher in CSA group than in the other groups. There were 44.6% patients with hyperglycemia in APA group ,and 48.8% in CSA group. The prevalence of hypertension was the highest in APA and EH group ,followed by CSA group ,NAA and control groups. There were 55.4% patients with lipid disturbance in APA group , and 46.5% in CSA group. (2 ) We divided all APA and CSA patients into groups with or without MS. The APA patients with MS had higher plasma aldosterone than those without MS. The CSA patients with MS had higher 08 :00 and 24 :00 plasma cortisol than those without MS. (3) After operation ,the plasma and urinary aldosterone were decreased and the plasma potassium was increased in APA patients. The 08 :00 ,24 :00 plasma cortisol and urinary cortisol were decreased and the 08 :00 plasma ACTH was increased in CSA patients. There were no significant differences in hormonal measurements of NAA patients before and after operation. (4 ) The prevalence of MS was 27.7% ,27.9% and 29.2% in three groups after operation. The systolic and diastolic blood pressures were decreased in APA patients after operation ,and the systolic blood pressure decreased in CSA patients. There was no significant difference in MS measurements of NAA patients before and after operation. Conclusions Our study indicates that patients with functional adrenocortical adenoma have a significantly higher prevalence of metabolic syndrome which is related to over secretion of adrenal cortex hormone. After operation ,accompanying normalization of hormonal secretion ,the condition of MS in functional adrenocortical adenoma patients is improved.

A Case of Aldosteronoma Complicated with Hyperthyroidism / 대한내분비학회지

Primary aldosteronism is characterized by hypokalemic metabolic alkalosis, low plasma renin activity, elevated plasma aldosterone level and can be suspected in the patients with hypertension and unexplained hypokalemia. Small adrenal cortical adenomas are responsible for this syndrome in most cases. The incidence of thyrotoxic periodic paralysis ranges from 1.9 to 6.2 % in Japan. Thyrotoxic periodic paralysis usually subsides following treatment of hyperthyroidism and has good prognosis. A 56 year-old man presented with hyperthyroidism, hypertension and recurrent hypokalemia. During the treatment of hyperthyroidism, he repeatedly experienced weakness of both lower extremities. Hormonal evaluation was performed and he was found to have a 2*2*1.5 cm sized right adrenal tumor by abdominal computerized topography(CT). After right adrenalectomy, hypokalemic periodic paralysis was improved. Both thyroid and adrenal function should be comprehensively investigated in periodic paralysis. In conclusion, physicians must be aware of the possibility of primary aldosteronism in hyperthyroid patients with hypokalemic periodic paralysis. We report a case of aldosteronoma complicated with hyperthyroidism and literatures are reviewed.

A Case of Aldosteronoma / 대한비뇨기과학회지

Primary Aldosteronism is characterized by hypertension, hypokalemic alkalosis and increased aldosterone secretion. It is important to distinguish between adenoma and hyperplasia for the treatment of primary aldosteronism because the hypertension associated with the adenomatous form is more likely to respond to operative removal. We report a case of aldosterone producing adrenal adenoma which was diagnosed by postural stimulation test of aldosterone and abdominal computed tomography, and was treated by adrenalectomy. A week after surgery, the blood pressure and laboratory data returned to normal.

A Case of Aldosteronoma / 대한비뇨기과학회지

Primary aldosteronism, characterized by hypertension, hypokalemia and hyperaldosteronemia caused by chronic overproduction of aldosterone independent of normal renin-angiotensin system, due to aldosteronoma, or to bilateral cortical nodular hyperplasia, or to adrenal carcinoma rarely. We report a case of left adrenal adenoma which was diagnosed by classic clinical symptoms, laboratory data, adrenal venography and abdominal computerized tomography. We performed left adrenalectomy with subcostal transperitoneal approach, and then blood pressure and laboratory data were normalized postoperatively.

Two Cases of Aldosteronoma / 대한비뇨기과학회지

Primary aldosteronism, characterized by hypertension, hypokalemia, and hyperaldosteronemia resulting from chronic oversecretion of aldosterone independent of normal renin-angiotensin regulatory system, is due mostly to aldosteronoma or to bilateral cortical nodular hyperplasia. We report two cases of primary aldosteronism due to adrenal cortical adenoma, which were diagnosed by clinical data and abdominal computed tomographic scan. Clinical symptoms and laboratory data returned to normal after surgical adrenalectomy.