Adolescent ; Adrenalectomy ; adverse effects ; methods ; Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Laparoscopy ; adverse effects ; methods ; Male ; Middle Aged

Hyperkalemia was one of the complications after primary aldosteronism surgery. Hyperkalemia after primary aldosteronism surgery was uncommon in clinical practice, especially persistent and serious hyperkalemia was rare. This complication was not attached great importance in clinical work. A case about persistent and serious hyperkalemia after primary aldosteronism adrenal adenoma surgery was reported and the patient was followed-up for fourteen months in this study. This patient had a laparoscopic adrenalectomy due to primary aldosteronism. Hyperkalemia was detected one month after surgery of this patient, the highest level of plasma potassium was 7.0 mmol/L. The patient felt skin itchy, nausea, palpitation. Plasma aldosterone concentration fell to 2.12 ng/dL post-operation from 35.69 ng/dL pre-operation, zona glomerulosa insufficiency was confirmed by hormonal tests in this patient after surgery. And levels of 24 hours urinary potassium excretion declined. Decrease of aldosterone levels after surgery might be the cause of hyperkalemia. Hyperkalemia lasted for 14 months after surgery and kalemia-lowering drugs were needed. A systemic search with "primary aldosteronism", "hyperkalemia", "surgical treatment" was performed in PubMed and Wanfang Database for articles published between January 2009 and December 2019. Literature review indicated that the incidence of hyperkalemia after primary aldosteronism surgery was 6% to 29%. Most of them was mild to moderator hyperkalemia (plasma potassium 5.5 to 6.0 mmol/L) and transient. 19% to 33% in hyperkalemia patients was persistent hyperkalemia. Previous studies in the levels of plasma potassium reached the level as high as 7 mmol/L in our case were rare. Whether hypoaldosteronemia was the cause of hyperkalemia was not consistent in the published studies. Risk factors of hyperkalemia after primary aldosteronism surgery included kidney dysfunction, old age, long duration of hypertention. This paper aimed to improve doctors' aweareness of hyperkalemia complication after primary aldosteronism surgery. Plasma potassium should be monitored closely after primary aldosteronism surgery, especially in the patients with risk factors. Some patients could have persistent and serious hyperkalemia, and need medicine treatment.
Adrenalectomy/adverse effects* ; Aldosterone/therapeutic use* ; Humans ; Hyperaldosteronism/surgery* ; Hyperkalemia/surgery* ; Potassium/therapeutic use*

Unilateral adrenalectomy was performed in six black Bengal goat (Capra hircus)to study electrocardiograph in connection with mineral metabolism with special reference to sodium and potassium and some other factors of physiological importance. The parameters were studied at every 12 hrs interval upto 120 hrs and 24 hrs interval from 120 to 240 hrs.Physiological parameters, like body weight and rectal temperature, changed non-significantly (p<0.05)after adrenalectomy. Among minerals, plasma sodium (p<0.01)and plasma potassium (p<0.05) concentration were changed significantly between hours leaving impression in ECG as widening of QRS complex and peaked T wave with increased amplitude found after unilateral adrenalectomy. Heart rate also increased significantly (p<0.01)between hours.
*Adrenalectomy ; Animals ; Body Temperature ; Body Weight ; *Electrocardiography/adverse effects ; Female ; Goats ; Heart Rate ; Potassium/*metabolism ; Sodium/*metabolism

OBJECTIVE: To analyze the risk factors of persistent hypertension in patients who underwent adrenalectomy for primary aldosteronism and to evaluate the predictive value of the aldosteronoma resolution score (ARS) scoring system for surgical outcomes of adrenalectomy for primary aldosteronism. METHODS: We reviewed the clinical characteristics of patients who underwent adrenalectomy for primary aldosteronism from 2018 to 2021 at Peking University People' s Hospital to recognize risk factors of uncured hypertension after surgery. Based on the patient' s clinical outcomes, the patients were divided into complete success group and partial/absent success group. Risk factors for persistent hypertension were analyzed. The value of the ARS scoring system was assessed by the area under the curve (AUC). RESULTS: In this study, 112 patients were included. Most of the patients benefited from the surgery for 94.6% were a complete or partial clinical success after follow-up for at least 6 months. According to postoperative hypertension status, the patients were divided into complete success group (51 cases) and partial/absent success group (61 cases). There were statistical differences between the two groups in age, body mass index (BMI), waist circumference, duration of hypertension, number of preoperative antihypertension medications, preoperative systolic blood pressure, history of diabetes, history of cardiovascular and cerebrovascular diseases, serum creatinine, estimated glomerular filtration rate(eGFR), high-density lipoprotein cholesterol and triglyceride. Logistic regression analysis showed that age (OR=1.111, 95%CI: 1.029-1.199), waist circumference (OR=1.073, 95%CI: 1.013-1.137), pre-operative systolic blood pressure (OR=1.033, 95%CI: 1.008-1.060) and history of cardiovascular and cerebrovascular diseases (OR=16.061, 95%CI: 1.312-196.612) were the risk factors for uncured hypertension in primary aldosteronism patients after surgery, but female gender not. The median ARS in the complete success group was 4 and in the partial/absent success group, it was 2. Among the patients with ARS of 4-5, the cure rate of hypertension was 76.5%. The area under the curve of ARS was 0.743. CONCLUSION The history of cardiovascular and cerebrovascular diseases is a significant risk factor for persistent hypertension after surgery in primary aldosteronism patients. ARS scoring system has a certain value in predicting the postoperative hypertension status of primary aldosteronism patients. However, further research is still needed on a prediction model for surgical outcomes of primary aldosteronism which is more suitable for the Chinese population is still needed.
Adrenalectomy/adverse effects* ; Blood Pressure ; Female ; Humans ; Hyperaldosteronism/surgery* ; Hypertension/etiology* ; Retrospective Studies ; Risk Factors ; Treatment Outcome

Primary aldosteronism (PA) is the most common form of secondary hypertension, with its main manifestations including hypertension and hypokalemia. Early identification of PA is extremely important as PA patients can easily develop cardiovascular complications such as atrial fibrillation, stroke, and myocardial infarction. The past decade has witnessed the rapid advances in the genetics of PA, which has shed new light on PA treatment. While surgery is the first choice for unilateral diseases, bilateral lesions can be treated with mineralocorticoid receptor antagonists (MRAs). The next-generation non-steroidal MRAs are under investigations. New medications including calcium channel blockers, macrophage antibiotics, and aldosterone synthase inhibitors have provided a new perspective for the medical treatment of PA.
Humans ; Hyperaldosteronism/complications* ; Adrenalectomy/adverse effects* ; Aldosterone/therapeutic use* ; Hypertension/drug therapy* ; Mineralocorticoid Receptor Antagonists/therapeutic use*

OBJECTIVETo investigate the anesthetic management features of laparoscopic adrenalectomy for pheochromocytoma.

METHODSTwelve patients scheduled for laparoscopic adrenalectomy for pheochromocytoma under general anesthesia were allocated into group 1, while another 12 patients who received transabdominal adrenalectomy for pheochromocytoma under general anesthesia were selected as group 2. The hemodynamic changes and the postoperative recovery profiles between the two groups were compared.

RESULTSHemodynamic fluctuation occurred during carbon dioxide insufflation and tumor manipulation in group 1. However, there were no differences between the two groups. Duration of post operative recovery and hospital stay as well as requirement of analgesics in group 1 were significantly lower than those in group 2 (P < 0.05).

CONCLUSIONHemodynamic fluctuation still exists during laparoscopic adrenalectomy for pheochromacytoma. However, patients undergoing such surgical procedure recover faster as compared with open surgery.

Adrenal Gland Neoplasms ; physiopathology ; surgery ; Adrenalectomy ; methods ; Adult ; Anesthesia, General ; Blood Pressure ; Female ; Heart Rate ; Humans ; Intraoperative Complications ; prevention & control ; Laparoscopy ; Male ; Middle Aged ; Monitoring, Intraoperative ; Pheochromocytoma ; physiopathology ; surgery ; Pneumoperitoneum, Artificial ; adverse effects

OBJECTIVETo discuss the effects of adrenalectomy (ADX) on the treatment of Cushing's disease(CD).

METHODSClinical data of 15 cases of CD between January 1980 and December 2005 were analyzed to evaluate operative indications, complications and the changes of hypercortisolism and hormone levels pre- and post- adrenalectomy.

RESULTSAll the patients involved underwent transsphenoidal pituitary surgery previously. Repeated transsphenoidal surgery was performed in 4 cases. Pituitary radiotherapy was done in 4 cases. The average time from original transsphenoidal operation to ADX was 25.7 months. Pre- and post- adrenalectomy serum cortisol median level were 1156.4 nmol/L and 99.4 nmol/L, the 24 h urinary-free cortisol median level were 315.0 and 5.4 microg, respectively. Hormone replacement therapy was needed in all cases. Average follow-up period was 47 months (9-120 months). Nelson syndrome (NS) appeared in 5 cases (33.3%), while 10 cases showed no NS.

CONCLUSIONSADX is an effective and symptomatic treatment to relieve hypercortisolism caused by CD but with the risk of NS. Longtime hormone replacement therapy and follow up are needed after ADX.

Adolescent ; Adrenalectomy ; adverse effects ; methods ; Adrenocorticotropic Hormone ; blood ; Adult ; Child ; Female ; Follow-Up Studies ; Humans ; Hydrocortisone ; blood ; Male ; Middle Aged ; Nelson Syndrome ; etiology ; prevention & control ; Pituitary ACTH Hypersecretion ; blood ; surgery ; Postoperative Complications ; prevention & control ; Retrospective Studies ; Treatment Outcome