title: Single-center outcome of laparoscopic unilateral adrenalectomy for patients with primary aldosteronism: lateralizing disease using results of adrenal venous sampling.
abstract: OBJECTIVE
  To assess the clinical effect of the universal use of adrenal venous sampling and to investigate the characteristics of patients with primary aldosteronism undergoing laparoscopic adrenalectomy at a single tertiary care center.
  
  
  METHODS
  After the screening examination, confirmatory test, and computed tomography (CT) scans were completed, all patients with biochemically diagnosed hyperaldosteronism underwent adrenal venous sampling to differentiate unilateral disease from bilateral idiopathic hyperaldosteronism. A total of 174 consecutive patients with unilateral aldosterone excess underwent unilateral laparoscopic adrenalectomy.
  
  
  RESULTS
  The surgically treated cohort was divided into 3 groups according to the CT findings. A total of 129 patients (74.1%) had findings associated with CT-positive macroadenoma (type 1A) and 42 (24.1%) with CT-negative microadenoma (type 2A). Only 3 patients (1.8%) had adrenocortical hyperplasia (type 3). The aldosterone level was normalized in all but 2 patients (98.9%), and the number of antihypertensive agents was significantly reduced within 1 month after adrenalectomy. Of the 174 patients, 155 (89.1%) showed resolution or improvement of hypertension.
  
  
  CONCLUSIONS
  The routine use of adrenal venous sampling could adequately detect lateralization in patients with unilateral aldosterone excess, which led to satisfactory short-term outcomes after surgery. The results of the present study showed that nearly one fourth of patients with the unilateral form had a CT-negative aldosterone-producing microadenoma.
authors.affiliation: Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan. ishidoya@uro.med.tohoku.ac.jp
authors.forename: Shigeto
authors.initials: S
authors.lastname: Ishidoya
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kaiho
authors.forename: Akihiro
authors.initials: A
authors.lastname: Ito
authors.forename: Ryo
authors.initials: R
authors.lastname: Morimoto
authors.forename: Fumitoshi
authors.initials: F
authors.lastname: Satoh
authors.forename: Sadayoshi
authors.initials: S
authors.lastname: Ito
authors.forename: Tadashi
authors.initials: T
authors.lastname: Ishibashi
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Hironobu
authors.initials: H
authors.lastname: Sasano
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Arai
mesh_terms: D000315:Adrenalectomy / Q000379:methods*; D000450:Aldosterone / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006403:Hematologic Tests; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000450:Aldosterone