SFE/SFHTA/AFCE consensus on primary aldosteronism, part 6: Adrenal surgery.
Treatment of primary aldosteronism (PA) aims at preventing or correcting hypertension, hypokalemia and target organ damage. Patients with lateralized PA and candidates for surgery may be managed by laparoscopic adrenalectomy. Partial adrenalectomy and non-surgical ablation have no proven advantage over total adrenalectomy. Intraoperative morbidity and mortality are low in reference centers, and day-surgery is warranted in selected cases. Spironolactone administered during the weeks preceding surgery controls hypertension and hypokalemia and may prevent postoperative hypoaldosteronism. In most cases, surgery corrects hypokalemia, improves control of hypertension and reduces the burden of pharmacologic treatment; in about 40% of cases, it resolves hypertension. However, success in controlling hypertension and reversing target organ damage is comparable with mineralocorticoid receptor antagonists. Informed patient preference with regard to surgery is thus an important factor in therapeutic decision-making.
Service de médecine interne, hôpital Tenon, AP-HP, 75020 Paris, France; Sorbonne universités, UPMC université Paris 06, faculté de médecine, 75006 Paris, France. Electronic address: olivier.steichen@tnn.aphp.fr.
Olivier
O
Steichen
Unité d'hypertension artérielle, AP-HP, HEGP, 75015 Paris, France; Sorbonne Paris Cité, université Paris Descartes, faculté de médecine, 75006 Paris, France.
Laurence
L
Amar
CHU Grenoble, département de chirurgie thoracique, vasculaire et endocrinienne, 38700 La Tronche, France; Laboratoire d'anatomie des Alpes françaises (LADAF), université Grenoble Alpes, UFR de médecine, 38700 La Tronche, France.
Philippe
P
Chaffanjon
Chirurgie générale et endocrinienne, hôpital Jean-Bernard, CHU de Poitiers, 86000 Poitiers, France; Faculté de médecine, université de Poitiers, 86000 Poitiers, France.
Jean-Louis
JL
Kraimps
Sorbonne universités, UPMC université Paris 06, faculté de médecine, 75006 Paris, France; Service de chirurgie digestive et viscérale, AP-HP, Pitié-Salpétrière, 75013 Paris, France.
Fabrice
F
Ménégaux
Sorbonne Paris Cité, université Paris Descartes, faculté de médecine, 75006 Paris, France; Service de chirurgie digestive, générale et cancérologique, AP-HP, HEGP, 75015 Paris, France.
Franck
F
Zinzindohoue
D000315:Adrenalectomy / Q000009:adverse effects / Q000379:methods; D005602:France; D006801:Humans; D006929:Hyperaldosteronism / Q000188:drug therapy / Q000601:surgery*; D006973:Hypertension / Q000188:drug therapy / Q000601:surgery; D007008:Hypokalemia / Q000188:drug therapy / Q000601:surgery; D007431:Intraoperative Complications; D010535:Laparoscopy; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D011183:Postoperative Complications; D013148:Spironolactone / Q000627:therapeutic use; D016896:Treatment Outcome
D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone
Adrenalectomy; Guiding factors; Hyperaldosteronism; Hyperaldostéronisme; Lignes directrices; Résultat thérapeutique; Surrénalectomie; Treatment outcome