Surgical treatment of two different pathological type primary aldosteronisms / 中华泌尿外科杂志

ABSTRACT

Objective To evaluate the clinical characteristics, surgical treatment effect and prognostic factors of post-operative hypertension in the 2 subtypes of primary aldosteronism (PHA),aldosterone adenoma (APA) and unilateral adrenal hyperplasia (UNAH). Methods In the collection of surgical treatment of PHA from 2002-2009, 135 cases, 68 males and 67 females, with age of 26-79 years (mean, 51 years) were analyzed. Of them, there were 83 APA patients, 52 UNAH cases. All the cases with PHA were with hypertension symptoms and met the preoperative diagnosis criteria. All the patients were performed preoperatively blood biochemical and hormonal tests and CT scans. The diagnosis was confirmed by pathology. All cases undergone adrenal reserved surgery (ASS) and followed-up. According to the postoperative recovery of blood pressure was normal or still in hypertension, Logistic regression analysis and comparison between the 2 groups were carried out,the clinical data of various factors in predicting the role of postoperative blood pressure were considered. Results One hundred and thirty-five patients were operated successfully. The mean follow up was 2. 5± 1.6 years (1-7 years). There were significant decreases in both systolic blood pressure and diastolic blood pressure at final follow up compared with those before surgery. Antihypertensive requirement was decreased at final follow-up. Serum aldosterone levels, plasma renin activity and potassium levels were improved significantly. Overall, blood pressure returned to normal in 51 cases(37.8%). Other 84 cases (62.2%) continued with high blood pressure, of whom 58 cases reduced antihypertensive drug use. Patient's age over 49.5 years, hypertension duration over 6. 5 years, family history of hypertension were higher risks of postoperative continuous high blood pressure. Conclusions APA and UNAH are 2 types of PHA with similar performance of patients, surgical treatment effect. ASS can be used in the treatment of these 2 types of disease. Age, hypertension duration, family history of hypertension are independent factors predicting sustained hypertension after surgery.