title: Retroperitoneoscopic adrenalectomy in Conn's syndrome caused by adrenal adenomas or nodular hyperplasia.
abstract: BACKGROUND
  In patients with primary hyperaldosteronism, solitary adrenal adenomas are an indication for surgical intervention. In contrast, adrenal hyperplasia is almost exclusively treated by drugs.
  
  
  METHODS
  In a prospective clinical study 183 patients (81 men, 102 women; age 49.6+/-12.8 years) with Conn's syndrome were operated on using the posterior retroperitoneoscopic approach. Tumor size ranged from 0.2 to 5.0 cm (mean 1.5+/-0.8 cm). Final histology described a solitary adenoma in 127 patients and adrenal hyperplasia in 56 patients. Partial adrenalectomies were performed in 47 operations.
  
  
  RESULTS
  The perioperative complication rate was 4%, mortality zero. In none of the cases was conversion to open surgery necessary. The mean operating time was 58+/-32 minutes (range 20-230 minutes) and was associated with sex (p<0.001) but not with the extent of resection (partial vs. total, p=0.51) or with tumor size (<or=1.5 vs. >1.5 cm; p=0.43) or tumor site (p=0.77). Median blood loss was 15 ml. Median duration of postoperative hospitalization was 4 days. After a mean follow-up of nearly 5 years, 96% of patients are normokalemic, 30% of patients are cured (normotensive without medication), and 87% showed an improvement of hypertension (normotensive without or with reduced medication). Cure of hypertension depended on the patient's age (p<0.001) and sex (p<0.001), duration of hypertension (p<0.05), and histomorphology (p<0.001). Improvement of hypertension was not associated with any of these factors.
  
  
  CONCLUSIONS
  Retroperitoneoscopic removal of adrenal glands in patients with Conn's syndrome is a safe, rapidly performed surgical procedure and can thus be considered as first choice option for treatment of both solitary adrenal adenomas and hyperplasia presenting with a clinically predominating nodule.
authors.affiliation: Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Kliniken Essen-Mitte, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Universität Duisburg-Essen, Henricistrasse 92, 45136 Essen, Germany. mkwalz@kliniken-essen-mitte.de
authors.forename: Martin K
authors.initials: MK
authors.lastname: Walz
authors.forename: Roland
authors.initials: R
authors.lastname: Gwosdz
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Levin
authors.forename: Piero F
authors.initials: PF
authors.lastname: Alesina
authors.forename: Anna-Carinna
authors.initials: AC
authors.lastname: Suttorp
authors.forename: Klaus A
authors.initials: KA
authors.lastname: Metz
authors.forename: Frank A
authors.initials: FA
authors.lastname: Wenger
authors.forename: Stephan
authors.initials: S
authors.lastname: Petersenn
authors.forename: Klaus
authors.initials: K
authors.lastname: Mann
authors.forename: Kurt W
authors.initials: KW
authors.lastname: Schmid
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D000311:Adrenal Glands / Q000473:pathology*; D000315:Adrenalectomy / Q000379:methods*; D018246:Adrenocortical Adenoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006929:Hyperaldosteronism / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D006965:Hyperplasia / Q000150:complications / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012187:Retroperitoneal Space