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Right Laparoscopic Adrenalectomy

Richard Hodin, MD
Massachusetts General Hospital

Abstract

Primary hyperaldosteronism or Conn's syndrome is a disease in which one or both adrenal gland produces excess amounts of aldosterone which leads to hypertension and hypokalemia. Common conditions resulting in this disorder include an adenoma in the adrenal gland or hyperplasia of both adrenal glands. In rare cases, it is caused by a malignant growth in the adrenal cortex or familial hyperaldosteronism. High blood pressure may cause headaches or blurred vision. Low potassium may cause fatigue, muscle cramps, muscle weakness, numbness, or temporary paralysis. Primary hyperaldosteronism is diagnosed by measuring the blood levels of aldosterone, renin, and potassium. Patients classically have high aldosterone levels, suppressed renin levels, and low potassium levels. Once the diagnosis is established, localization of the source is done through imaging studies. Adrenal vein sampling is also done to determine which side is producing excess aldosterone. Primary hyperaldosteronism caused by an adrenal gland tumor is treated with adrenalectomy. Approximately 95% of patients will notice significant improvement in their hypertension after a successful surgery. Here, we present the case of a 58-year-old female with hypokalemia and long-standing hypertension refractory to medical treatment. Her blood tests showed a high aldosterone level and a low renin level, which confirmed the diagnosis of hyperaldosteronism. On CT scan, an adrenal nodule was noted on both sides thus adrenal vein sampling was done, which identified the right adrenal nodule as the cause. 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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