title: Adrenal histologic findings show no difference in clinical presentation and outcome in primary hyperaldosteronism.
abstract: BACKGROUND
  Primary hyperaldosteronism is most commonly due to a solitary cortical adenoma. Thus, some surgeons have suggested a subtotal adrenalectomy is a reasonable approach when a mass can be identified. On the other hand, adrenal vein sampling (AVS) is being used more frequently to distinguish patients with unilateral disease for adrenalectomy, even if a discrete mass is not identified on axial imaging. In these cases, surgical pathology may reveal a cortical adenoma, a cortical adenoma with hyperplasia, or cortical hyperplasia. The goal of this study was to compare the presentation and outcome among patients undergoing adrenalectomy and found to have different histologic features.
  
  
  METHODS
  We performed a retrospective analysis of 136 patients with primary hyperaldosteronism. A total of 95 patients had an adrenalectomy for unilateral disease. The preoperative clinical and laboratory, and postoperative outcome of the three aforementioned histologic groups were compared.
  
  
  RESULTS
  A total of 95 patients underwent an adrenalectomy. We found no significant difference in age, gender, body mass index, duration of hypertension, number of antihypertensive medications, serum aldosterone level, serum renin level, or adrenal vein sampling ratios among the three histologic categories. We also found no significant difference among the three categories in postoperative cure rate.
  
  
  CONCLUSIONS
  The rate of unilateral hyperplasia in patients with primary hyperaldosteronism (16%) is likely higher than previously reported, which may be due to the increasing use of AVS. The clinical presentation and outcome of patients regardless of the histologic findings are similar. Our data also suggests that subtotal adrenalectomy would not be appropriate in patients with primary hyperaldosteronism.
authors.affiliation: Endocrine Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA. abweisbrod@gmail.com
authors.forename: Allison B
authors.initials: AB
authors.lastname: Weisbrod
authors.forename: Richard C
authors.initials: RC
authors.lastname: Webb
authors.forename: Aarti
authors.initials: A
authors.lastname: Mathur
authors.forename: Stephanie
authors.initials: S
authors.lastname: Barak
authors.forename: Smita Baid
authors.initials: SB
authors.lastname: Abraham
authors.forename: Naris
authors.initials: N
authors.lastname: Nilubol
authors.forename: Martha
authors.initials: M
authors.lastname: Quezado
authors.forename: Constantine A
authors.initials: CA
authors.lastname: Stratakis
authors.forename: Electron
authors.initials: E
authors.lastname: Kebebew
mesh_terms: D000236:Adenoma / Q000150:complications / Q000473:pathology* / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D000311:Adrenal Glands / Q000473:pathology* / Q000601:surgery; D000315:Adrenalectomy; D000450:Aldosterone / Q000097:blood; D000959:Antihypertensive Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications / Q000473:pathology* / Q000601:surgery; D006965:Hyperplasia / Q000150:complications / Q000473:pathology* / Q000601:surgery; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents; D000450:Aldosterone