title: Clinical risk factors of postoperative hyperkalemia after adrenalectomy in patients with aldosterone-producing adenoma.
abstract: OBJECTIVE
  Unilateral adrenalectomy is the first-line treatment for aldosterone-producing adenomas (APA). Hyperkalemia after adrenalectomy because of contralateral zona glomerulosa insufficiency has been reported. We investigated clinical risk factors to predict postoperative hyperkalemia in patients with APA undergoing adrenalectomy.
  
  
  METHODS
  This study was conducted by retrospectively reviewing medical records from 2000 to 2012 at Seoul National University Hospital and two other tertiary centers. Data from 124 patients who underwent adrenalectomy were included. Hyperkalemia was defined as serum potassium >5.5 mmol/l. Clinical preoperative risk factors included age, blood pressure, plasma renin activity (PRA), plasma aldosterone concentration (PAC), serum potassium, serum creatinine, glomerular filtration rate (GFR), the mass size on pathology, and mineralocorticoid receptor (MR) antagonist use.
  
  
  RESULTS
  Out of 124 patients, 13 (10.5%) developed postoperative hyperkalemia. The incidences of transient and persistent hyperkalemia were 3.2 and 7.3% respectively. Preoperative PRA and PAC were not significantly different in postoperative hyperkalemic patients compared with normokalemic patients. Patients with persistent hyperkalemia were older, had a longer duration of hypertension, larger mass size on pathology, and lower GFR (all P<0.05). The incidence of postoperative hyperkalemia was not different between MR antagonist users and non-users.
  
  
  CONCLUSIONS
  Older age (≥53 years), longer duration of hypertension (≥9.5 years), larger mass size on pathology (≥1.95 cm), and impaired preoperative renal function (GFR <58.2 ml/min) were associated with prolonged postoperative hyperkalemia in patients with APA. MR antagonist use did not prevent postoperative hyperkalemia.
authors.affiliation: Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, KoreaDepartment of Internal MedicineSeoul Metropolitan Government Borame Medical Center, Seoul 156-707, South KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam-city, Gyeonggi-do, South Korea.
authors.forename: Kyeong Seon
authors.initials: KS
authors.lastname: Park
authors.affiliation: Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, KoreaDepartment of Internal MedicineSeoul Metropolitan Government Borame Medical Center, Seoul 156-707, South KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam-city, Gyeonggi-do, South Korea.
authors.forename: Jung Hee
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, KoreaDepartment of Internal MedicineSeoul Metropolitan Government Borame Medical Center, Seoul 156-707, South KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam-city, Gyeonggi-do, South Korea.
authors.forename: Eu Jeong
authors.initials: EJ
authors.lastname: Ku
authors.affiliation: Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, KoreaDepartment of Internal MedicineSeoul Metropolitan Government Borame Medical Center, Seoul 156-707, South KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam-city, Gyeonggi-do, South Korea.
authors.forename: A Ram
authors.initials: AR
authors.lastname: Hong
authors.affiliation: Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, KoreaDepartment of Internal MedicineSeoul Metropolitan Government Borame Medical Center, Seoul 156-707, South KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam-city, Gyeonggi-do, South Korea Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, KoreaDepartment of Internal MedicineSeoul Metropolitan Government Borame Medical Center, Seoul 156-707, South KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam-city, Gyeonggi-do, South Korea.
authors.forename: Min Kyong
authors.initials: MK
authors.lastname: Moon
authors.affiliation: Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, KoreaDepartment of Internal MedicineSeoul Metropolitan Government Borame Medical Center, Seoul 156-707, South KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam-city, Gyeonggi-do, South Korea Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, KoreaDepartment of Internal MedicineSeoul Metropolitan Government Borame Medical Center, Seoul 156-707, South KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam-city, Gyeonggi-do, South Korea.
authors.forename: Sung Hee
authors.initials: SH
authors.lastname: Choi
authors.affiliation: Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, KoreaDepartment of Internal MedicineSeoul Metropolitan Government Borame Medical Center, Seoul 156-707, South KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam-city, Gyeonggi-do, South Korea.
authors.forename: Chan Soo
authors.initials: CS
authors.lastname: Shin
authors.affiliation: Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, KoreaDepartment of Internal MedicineSeoul Metropolitan Government Borame Medical Center, Seoul 156-707, South KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam-city, Gyeonggi-do, South Korea Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, KoreaDepartment of Internal MedicineSeoul Metropolitan Government Borame Medical Center, Seoul 156-707, South KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam-city, Gyeonggi-do, South Korea seongyk@plaza.snu.ac.kr swkimmd@snu.ac.kr.
authors.forename: Sang Wan
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, KoreaDepartment of Internal MedicineSeoul Metropolitan Government Borame Medical Center, Seoul 156-707, South KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam-city, Gyeonggi-do, South Korea seongyk@plaza.snu.ac.kr swkimmd@snu.ac.kr.
authors.forename: Seong Yeon
authors.initials: SY
authors.lastname: Kim
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects*; D018246:Adrenocortical Adenoma / Q000097:blood / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood*; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000097:blood / Q000209:etiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011379:Prognosis; D012083:Renin / Q000097:blood; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000450:Aldosterone; D012083:Renin