Conn syndrome: 14 year's experience from two European centres.
OBJECTIVE
To evaluate the long term results of adrenalectomy for primary hyperaldosteronism.


METHODS
Multicentre retrospective cohort study.


METHODS
Two university hospitals, UK and Italy.


METHODS
55 patients who presented with a mean (SD) preoperative blood pressure of 181/110 (21/10) mmHg and a mean (SD) potassium of 2.8 (0.4) mmol/L (range 1.6-4) during the period October 1978 to October 1992.


METHODS
Unilateral adrenalectomy, usually by the extraperitoneal approach. Adrenalectomy was total in all but nine cases.


METHODS
Accuracy of preoperative investigations for the diagnosis and localisation of the lesions, histology, morbidity and mortality, long term outcome (mean follow up 8.8 years).


RESULTS
Computed tomography gave a diagnostic accuracy for unilateral lesions of 88%, the postural stimulation test 80%, norcholesterol scintigraphy 84%, and ultrasonography 57%. Histological examination showed carcinoma (n = 1), diffuse hyperplasia (n = 2), nodular hyperplasia (n = 11) including 5 with macronodular hyperplasia, double adenoma (n = 1) and single adenoma (n = 40). No patient died, and 10 developed minor complications. At the latest follow-up 44/52 patients with benign unilateral lesions (85%) have been cured by adrenalectomy.


CONCLUSIONS
Our results confirm the safety of the extraperitoneal approach, and suggest that the improvement in the accuracy of preoperative investigations has allowed a careful selection of patients with the consequent amelioration of the long term outcome of surgery for Conn's syndrome. As laparoscopic adrenalectomy is currently advocated as the operation of choice for surgically-remediable mineralocorticoid excess, its long term results will have to be comparable with these standards.
Puccini
M
M
Department of Surgery, University of Pisa, Italy.
Iacconi
P
P
Bernini
G
G
Miccoli
P
P
Lynn
J A
JA
D000315:Adrenalectomy; D000328:Adult; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome