Clinical outcomes of laparoscopic adrenalectomy for lateralizing nodular hyperplasia

Abstract

Background: Nodular adrenal hyperplasia (NAH) may mimic the biochemical characteristics of an aldosterone-producing adenoma. The authors evaluated the outcomes of unilateral laparoscopic adrenalectomy in the setting of lateralizing aldosterone hypersecretion by NAH.

Methods: Retrospective review of consecutive patients who underwent a laparoscopic adrenalectomy for primary hyperaldosteronism owing to NAH was performed. Patient demographics, perioperative symptoms, medications, radiographic findings, and serum chemistries were analyzed. Response to operation was classified according to postoperative control of hypertension and hypokalemia as resolved, improved, or refractory.

Results: From January 1999 to October 2004, 15 patients underwent a laparoscopic unilateral adrenalectomy for hyperaldosteronism owing to lateralizing NAH. Nine (60%) patients presented with > or =5 years of hypertension, including 8 (53%) patients with labile or malignant hypertension. Ten (67%) patients had hypokalemia. Abdominal imaging results were normal in 9 (60%) patients. All patients underwent adrenal venous sampling (94% successfully), which revealed an average adjusted aldosterone ratio of 17.6 (range, 1.2 to 75.9). At a mean follow-up of 26 (range, 4 to 58) months, hypertension had resolved in 4 (27%), improved in 8 (53%), and was refractory in 3 (20%) patients. Hypokalemia resolved in all patients. There were no complications, conversions, or mortalities.

Conclusion: This series shows that unilateral adrenalectomy for lateralizing NAH results in eradication of hypokalemia and resolution or significant improvement in hypertension in 80% of patients at long-term follow-up. When lateralization of aldosterone production is noted, laparoscopic adrenalectomy provides significant clinical improvement even in patients with a pathologic diagnosis of NAH.