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Laparoscopic Left Adrenalectomy

Richard Hodin, MD
Massachusetts General Hospital

Abstract

Primary hyperaldosteronism refers to the autonomous secretion of the hormone aldosterone from the adrenal gland resulting in low renin levels. This usually occurs in individuals between the ages of 30 to 50 years old. The majority of these cases are caused either by a solitary, functioning adrenal adenoma or aldosteronoma (70%) or by idiopathic bilateral hyperplasia (30%). Other uncommon causes include adrenal carcinoma and familial hyperaldosteronism. Patients typically present with hypokalemia and long-standing hypertension that is difficult to control despite multi-drug threrapy, but further tests are required for diagnosis. An elevated plasma aldosterone level with a suppressed plasma renin level is strongly suggestive of the diagnosis. Once confirmed, further evaluation should be directed at determining if the cause is a unilateral aldosteronoma or bilateral adrenal hyperplasia. This is done through imagine studies and adrenal vein sampling. Unilateral aldosteronoma is best managed by adrenalectomy with the laparoscopic approach being the preferred method, while bilateral adrenal hyperplasia is often best treated medically since only 20-30% benefit from surgery. Here, we present a 48-year-old female who had long-standing hypertension and hypokalemia and was found to have hyperaldosteronism and low renin levels. A CT scan showed a small mass on the left adrenal gland, and adrenal vein sampling showed high levels of aldosterone on the left side compared with the right, confirming a unilateral aldosteronoma. Laparoscopic access was gained, the adrenal gland was dissected and exposed, the adrenal vessels were ligated, and the adrenal gland was removed.

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