title: Laparoscopic adrenalectomy on a patient with primary aldosteronism during pregnancy.
abstract: A pregnant 26-year-old woman was referred for evaluation and management of progressive hypertension and hypokalemia at 14 weeks of gestation. Her plasma aldosterone level was markedly elevated and magnetic resonance imaging showed a right adrenal tumor. Primary aldosteronism due to an aldosterone producing-adenoma was diagnosed. Because of progressive severe hypertension, a laparoscopic adrenalectomy was performed at 17 weeks of gestation. The procedure was completed without complication, and plasma aldosterone and potassium levels rapidly improved post-operatively. However, her hypertension persisted and the growth retardation of the fetus was found. Regrettably, intrauterine fetal death was confirmed at 26 weeks of gestation. Histological examination of the placenta revealed that the placental artery had very thick walls which had apparently caused a critical failure in fetal blood flow. The optimal timing of laparoscopic surgery during pregnancy and perioperative management were subsequently discussed.
authors.affiliation: Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Kinshi
authors.initials: K
authors.lastname: Kosaka
authors.forename: Naoyoshi
authors.initials: N
authors.lastname: Onoda
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Naoko
authors.initials: N
authors.lastname: Iwanaga
authors.forename: Seiichi
authors.initials: S
authors.lastname: Yamamasu
authors.forename: Hideki
authors.initials: H
authors.lastname: Tahara
authors.forename: Masaaki
authors.initials: M
authors.lastname: Inaba
authors.forename: Eiji
authors.initials: E
authors.lastname: Ishimura
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Ogawa
authors.forename: Kosei
authors.initials: K
authors.lastname: Hirakawa
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy; D000328:Adult; D005260:Female; D005313:Fetal Death; D006801:Humans; D006929:Hyperaldosteronism / Q000473:pathology / Q000601:surgery; D006973:Hypertension / Q000188:drug therapy; D010535:Laparoscopy; D011188:Potassium / Q000097:blood; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000473:pathology / Q000601:surgery*
chemical_list: D011188:Potassium