Surgical treatment for unilateral primary hyperaldosteronism in Iceland: with one year follow up

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 723-757-Renin-Angiotensin-Aldosterone System/Endocrine Hypertension
Bench to Bedside
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-747
Gudbjörg Jónsdóttir*, Jón Gudmundsson, Gudjón Birgisson and Helga Agusta Sigurjonsdottir
Landspitali University Hospital, Reykjavik, Iceland
Introduction: In 2007 a standardized protocol was started for diagnosing and treating unilateral primary hyperaldosteronism in Iceland as adrenal venous sampling (AVS) became available. The aim of this study was to gather information regarding outcome after surgery.

Methods: A retrospective chart review was performed of all patients (age 18 and older) diagnosed with primary aldosteronism during 2007 through 2011 at the Landspitali University Hospital in Iceland, a referral center for the whole country (population of 318.000). All patients were diagnosed using the same standardized methods. After pharmacological modification, screening and verification testing, with salt loading and positional tests, all patients where further examined with a CT scan and AVS. When AVS indicated unilateral disease, patients were offered a laparoscopic total adrenalectomy. All patients were followed by the same endocrinologist postoperatively. Mean blood pressure preoperatively was compared to blood pressure values at one year follow up. The need for both anti-hypertensive medications (HTM) and potassium supplementation was assessed pre- and postoperatively.

Results: Sixteen patients, 4 women and 12 men, were diagnosed with unilateral disease and all were treated with laparoscopic unilateral total adrenalectomy. There was no loss to follow up. Hypertension improvement or cure was seen in 75% (12/16) of patients at one year follow up. The mean number of HTM preoperatively was 3.2 ± 1.3 compared to 2.1 ± 1.8 one year postoperatively. The number of HTM decreased in 53% (8/15) of patients. Potassium supplementation was 56% (9/16) before pharmacological modification, 75% (12/16) after pharmacological modification and 13% (2/15) postoperatively.

Conclusion: In our study laparascopic unilateral total adrenalectomy for unilateral primary hyperaldosteronism improved blood pressure, decreased the number of anti-hypertensive medications and almost eliminated the need for potassium supplementation at one year follow up.

Nothing to Disclose: GJ, JG, GB, HAS

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