Perioperative Assessment of Patients with Primary Aldosteronism at the Toronto University Health Network

Nicholas Gaudet, MD, Usmaan Hameed, MD, Allan Okrainec, MD, Todd Penner, MD, David R Urbach, MD

University of Toronto, University Health Network

Background: Laparoscopic adrenalectomy for primary aldosteronism due to unilateral hypersecretion has become the gold standard of surgical management. Current recommendations advocate confirmatory testing after initial diagnosis, followed by subtype classification and localization of the offending lesion.

Objectives: We aim to describe our experience in preoperative evaluation over the past 9 years at the Toronto University Health Network tertiary care center.

Methods: Data collection from electronic hospital records were used to compile patient demographics undergoing laparoscopic adrenalectomy from 2003-2011. A chart review of hospital records and outside referral workup was conducted including only biochemical investigations and diagnostic imaging obtained within one year of surgery.

Results: A total of 147 patients (mean age 52.5 yrs) underwent laparoscopic adrenalectomy from 2003-2011. Primary aldosteronism (PA) was the indication for surgery in 31 (21.2%) patients. PA was diagnosed in 28 (90.3%) patients by aldosterone : renin activity and was further investigated by saline suppression test in 9 (29.0%) patients, selective adrenal venous sampling in 15 (48.4%) patients, and MRI in 8 (25.8%) patients. One patient had evidence of PA after surgery, and was discovered to have a functioning aldosteronoma on the contralateral gland.

Conclusions: Primary care physicians and endocrinologists often complete a significant portion of the initial assessment of hyperaldosteronism. Surgeons must further confirm laterality and plan operative approach using adjunctive tests. Selective adrenal venous sampling was used in approximately half our patients with PA, and might have prevented one case of missed contralateral aldosteronoma if used more liberally.


Session: Podium Presentation

Program Number: S030

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