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Appropriate timing for a biochemical evaluation after adrenalectomy for unilateral aldosterone‐producing adenoma
Author(s) -
Takamatsu Kimiharu,
Takeda Toshikazu,
Hattori Seiya,
Tanaka Nobuyuki,
Morita Shinya,
Matsumoto Kazuhiro,
Kosaka Takeo,
Mizuno Ryuichi,
Shinojima Toshiaki,
Kikuchi Eiji,
Asanuma Hiroshi,
Kurihara Isao,
Itoh Hiroshi,
Oya Mototsugu
Publication year - 2020
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.14176
Subject(s) - aldosterone , adrenalectomy , medicine , endocrinology , context (archaeology) , adenoma , chemistry , primary aldosteronism , bilateral adrenalectomy , urology , biology , paleontology
Context The oversecretion of plasma aldosterone by unilateral aldosterone‐producing adenoma (APA) can be cured by adrenalectomy. However, the time needed for the endocrine environment to normalize remains unclear. Objective To clarify adequate timing for a biochemical evaluation in unilateral APA patients after adrenalectomy. Design and patients A total of 166 unilateral APA patients were retrospectively reviewed. We evaluated the plasma aldosterone concentration (PAC) (pg/mL), active renin concentration (ARC) (pg/mL), aldosterone‐renin ratio (ARR; PAC/ARC), serum potassium concentration and estimated glomerular filtration rate (eGFR) at 1, 3 and 6 postoperation months (POM). Results PAC was significantly lower at 1POM than at presurgery (presurgery; 407.2, 1 POM; 90.0 pg/mL, P < .001). ARC did not increase from baseline at 1POM, but significantly increased at 3POM (presurgery; 4.43, 1POM; 4.87, 3POM; 11.3 pg/mL, P < .001). ARR significantly decreased at 1POM (presurgery; 146.9, 1 POM; 26.3, P < .001) although ARC did not increase at 1POM. Among the 34 patients who had hypokalaemia presurgery, it was resolved in 28 (82%) at 1POM and in all (100%) at 3POM. The biochemical outcomes at 1POM were 131 (79%) complete, 20 (12%) partial and 15 (9%) absent successes, while at 3POM, 147 (89%) were complete, 9 (5%) partial and 10 (6%) absent. Twenty‐three (14%) patients were reclassified into different biochemical outcomes between 1 and 3POM, whereas only 5 (3%) changed between 3 and 6POM. Conclusion The appropriate timing for a biochemical evaluation of unilateral APA patients treated with laparoscopic adrenalectomy appears to be 3 months or more after surgery.