Tumor Size of Conn's Adenoma and Comorbidities

Abstract

Primary aldosteronism (PA) is associated with vascular end organ damage. The aim of the study was to evaluate differences regarding comorbidities depending on tumor size in patients with aldosterone producing adenoma (APA). The retrospective cross-sectional study was done by collection from 6 German centers (German Conn's registry) between 1990 and 2007. Among the 640 registered patients with PA, 60 operated patients with APA were analyzed. The main outcome of measures was the comorbidities depending on tumor size. Thirty-one patients (17 men, 14 women) had an adenoma size <20 mm, and 29 patients (10 men, 19 women) had an adenoma size≥20 mm. There was no difference in age, preoperative potassium, aldosterone, or creatinine levels, preoperative systolic and diastolic blood pressure, or duration of hypertension between the two groups. In the group with APA <20 mm, cerebrovascular events occurred with a prevalence of 12.9%, cardiac events 16.1%, peripheral vascular events 25.8%, renal insufficiency 16.1%, and sleep apnea 6.4%, respectively. There was no significant difference in comorbidities compared to the group with APA≥20 mm. Subgroup analysis (n=22) of follow-up data on post-operative systolic and diastolic blood pressure showed no significant difference between these subgroups with regard to potassium, aldosterone or creatinine levels, blood pressure, duration of hypertension, or comorbidities. Our data indicate a high prevalence of comorbidities in patients with APA. However, adenoma size was not correlated with cardio- and cerebrovascular comorbidities, and does not seem to be a prognostic factor for blood pressure outcome.

Key words

hyperaldosteronism - APA size - cerebrovascular and cardiac comorbidity - adrenal tumor size

References

• 1 Rossi GP, Bernini G, Caliumi C, Desideri G, Fabris B, Ferri C, Ganzaroli C, Giacchetti G, Letizia C, Maccario M, Mallamaci F, Mannelli M, Mattarello MJ, Moretti A, Palumbo G, Parenti G, Porteri E, Semplicini A, Rizzoni D, Rossi E, Boscaro M, Pessina AC, Mantero F. A prospective study of the prevalence of primary aldosteronism in 1 125 hypertensive patients.  J Am Coll Cardiol. 2006;  48 2293-2300
• 2 Rossi GP, Bernini G, Desideri G, Fabris B, Ferri C, Giacchetti G, Letizia C, Maccario M, Mannelli M, Matterello MJ, Montemurro D, Palumbo G, Rizzoni D, Rossi E, Pessina AC, Mantero F. Renal damage in primary aldosteronism: results of the PAPY Study.  Hypertension. 2006;  48 232-238
• 3 Rossi GP, Sacchetto A, Visentin P, Canali C, Graniero GR, Palatini P, Pessina AC. Changes in left ventricular anatomy and function in hypertension and primary aldosteronism.  Hypertension. 1996;  27 1039-1045
• 4 Suzuki T, Abe H, Nagata S, Saitoh F, Iwata S, Ashizawa A, Kuramochi M, Omae T. Left ventricular structural characteristics in unilateral renovascular hypertension and primary aldosteronism.  Am J Cardiol. 1988;  62 1224-1227
• 5 Catena C, Colussi G, Lapenna R, Nadalini E, Chiuch A, Gianfagna P, Sechi LA. Long-term cardiac effects of adrenalectomy or mineralocorticoid antagonists in patients with primary aldosteronism.  Hypertension. 2007;  50 911-918
• 6 Milliez P, Girerd X, Plouin PF, Blacher J, Safar ME, Mourad JJ. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism.  J Am Coll Cardiol. 2005;  45 1243-1248
• 7 Willenberg HS, Schinner S, Ansurudeen I. New mechanisms to control aldosterone synthesis.  Horm Metab Res. 2008;  40 435-441
• 8 Sechi LA, Novello M, Lapenna R, Baroselli S, Nadalini E, Colussi GL, Catena C. Long-term renal outcomes in patients with primary aldosteronism.  JAMA. 2006;  295 2638-2645
• 9 Shigematsu Y, Hamada M, Okayama H, Hara Y, Hayashi Y, Kodama K, Kohara K, Hiwada K. Left ventricular hypertrophy precedes other target-organ damage in primary aldosteronism.  Hypertension. 1997;  29 723-727
• 10 Catena C, Colussi G, Nadalini E, Chiuch A, Baroselli S, Lapenna R, Sechi LA. Cardiovascular outcomes in patients with primary aldosteronism after treatment.  Arch Intern Med. 2008;  168 80-85
• 11 Sawka AM, Young WF, Thompson GB, Grant CS, Farley DR, Leibson C, van Heerden JA. Primary aldosteronism: factors associated with normalization of blood pressure after surgery.  Ann Intern Med. 2001;  135 258-261
• 12 Celen O, O’Brien MJ, Melby JC, Beazley RM. Factors influencing outcome of surgery for primary aldosteronism.  Arch Surg. 1996;  131 646-650
• 13 Lo CY, Tam PC, Kung AW, Lam KS, Wong J. Primary aldosteronism. Results of surgical treatment.  Ann Surg. 1996;  224 125-130
• 14 Harris DA, Au-Yong I, Basnyat PS, Sadler GP, Wheeler MH. Review of surgical management of aldosterone secreting tumours of the adrenal cortex.  Eur J Surg Oncol. 2003;  29 467-474
• 15 Meyer A, Brabant G, Behrend M. Long-term follow-up after adrenalectomy for primary aldosteronism.  World J Surg. 2005;  29 155-159
• 16 Giacchetti G, Ronconi V, Rilli S, Guerrieri M, Turchi F, Boscaro M. Small tumor size as favourable prognostic factor after adrenalectomy in Conn's adenoma.  Eur J Endocrinol 2009. 160 639-646
• 17 Born-Frontsberg E, Reincke M, Rump LC, Hahner S, Diederich S, Lorenz R, Allolio B, Seufert J, Schirpenbach C, Beuschlein F, Bidlingmaier M, Endres S, Quinkler M. Cardio- and cerebrovascular comorbidites of hypo- and normokalemic primary aldosteronism: results of the German Conn's Registry.  J Clin Endocrinol Metab. 2009;  94 1125-1130
• 18 Reincke M, Rump C, Quinkler M, Hahner S, Diederich S, Lorenz R, Seufert J, Schirpenbach C, Beuschlein F, Bidlingmaier M, Meisinger C, Holle R, Endres S. Risk Factors Associated with a Low Glomerular Filtration Rate in Primary Aldosteronism.  J Clin Endocrinol Metab. 2009;  94 869-875
• 19 Fukudome Y, Fujii K, Arima H, Ohya Y, Tsuchihashi T, Abe I, Fujishima M. Discriminating factors for recurrent hypertension in patients with primary aldosteronism after adrenalectomy.  Hypertens Res. 2002;  25 11-18
• 20 Goh BK, Tan YH, Yip SK, Eng PH, Cheng CW. Outcome of patients undergoing laparoscopic adrenalectomy for primary hyperaldosteronism.  JSLS. 2004;  8 320-325
• 21 Rossi GP, Bolognesi M, Rizzoni D, Seccia TM, Piva A, Porteri E, Tiberio GA, Giulini SM, Gabiti-Rosei E, Pessina AC. Vascular remodeling and duration of hypertension predict outcome of adrenalectomy in primary aldosteronism patients.  Hypertension. 2008;  51 1366-1371
• 22 Walz MK, Gwosdz R, Levin SL, Alesina PF, Suttorp AC, Metz KA, Wenger FA, Petersenn S, Mann K, Schmid KW. Retroperitoneoscopic adrenalectomy in Conn's syndrome caused by adrenal adenomas or nodular hyperplasia.  World J Surg. 2008;  32 847-853
• 23 Pang TC, Bambach C, Monaghan JC, Sidhu SB, Bune A, Delbridge LW, Sywak MS. Outcomes of laparoscopic adrenalectomy for hyperaldosteronism.  ANZ J Surg 2007. 77 768-773
• 24 Brunt LM, Moley JF, Doherty GM, Lairmore TC, DeBenedetti MK, Quasebarth MA. Outcomes analysis in patients undergoing laparoscopic adrenalectomy for hormonally active adrenal tumors.  Surgery. 2001;  130 629-634
• 25 Meria P, Kempf BF, Hermieu JF, Plouin PF, Duclos JM. Laparoscopic management of primary hyperaldosteronism: clinical experience with 212 cases.  J Urol 2003. 169 32-35
• 26 Lumachi F, Ermani M, Basso SM, Armanini D, Iacobone M, Favia G. Long-term results of adrenalectomy in patients with aldosterone-producing adenomas: multivariate analysis of factors affecting unresolved hypertension and review of the literature.  Am Surg. 2005;  71 864-869

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