Zaporožskij Medicinskij Žurnal (Jun 2019)
Roentgenoendovascular destruction of adrenal glands in the management of primary aldosteronism
Abstract
Background. In the XXI century, interventional radiology is developing rapidly in the surgical treatment for endocrine pathology of adrenal glands. Until the introduction of aldosterone to renin ratio calculation as a screening test by K. Hiramatsu in 1981, primary aldosteronism was thought to be a rare pathology. Further study of the disease obtained new data on its prevalence – from 5 to 10 % among patients with hypertension and more than 20 % of patients with refractory hypertension. In Ukraine, the prevalence of primary aldosteronism among patients with refractory arterial hypertension is 1.2 %. The aim of the study was to evaluate the effectiveness of roentgenoendovascular destruction of adrenal glands (REDAG) in patients with primary aldosteronism (PA). Materials and methods. During the period from 2014 to July2018, a total of 132 patients with adrenal pathology were examined and treated at the Clinic of Hospital Surgery of ZSMU. Operative treatment for primary aldosteronism was performed in 38 patients, including 15 patients who underwent REDAG. There were 10 (66.7 %) women and 5 (33.3 %) men. The average age was 49.4 ± 14.9 years. According to CT (MRT), anatomy of adrenal neoplasms had the following localization: left-sided – in 11 (73.3 %) patients, right-sided – in 1 (6.7 %), bilateral – in 3 (20 %). The mean volume of adrenal neoplasms was 9.0 (6.3–10.0) mm. Diagnostics was performed according to the clinical practical recommendations for the diagnosis and treatment of PA (Clinical Practical Guideline – The Management of Primary Aldosteronism, 2016). Roentgenoendovascular surgery in patients with PA included destruction of the right adrenal gland in 3 (20 %) cases, of the left – in 12 (80 %). The results of the operative treatment were evaluated according to the standard criteria and clinical biochemical criteria of PASO (Primary Aldosteronism Surgical Outcomes) including the echocardiographic data. Results. The duration of the REDAG was 36.6 ± 6 minutes. Conversions, postoperative complications, lethal outcomes were avoided. The length of hospital stay was 9 (7–12) days. Comparative analysis of surgical treatment results showed a statistically significant decrease in systolic and diastolic blood pressure, aldosterone levels (P < 0.05). The control CT performed after treatment identified adrenal adenomas in the contralateral glands in 2 (13.3 %) patients. However, the follow-up clinical and laboratory diagnostics did not reveal its hormonal activity. According to PASO criteria, the complete biochemical effect was achieved in 73.3 %, complete clinical - in 66.7 %, partial biochemical effect – in 20 %, partial clinical effect – in 26.6 % of patients, failure of biochemical and clinical effects – in 6.7 %. Conclusions. Interventional methods of surgical treatment for adrenal pathology represent a complete alternative to endoscopic methods of surgical treatment in case if it is clinically indicated. REDAG for primary aldosteronism demonstrates the statistically significant efficacy of symptomatic arterial hypertension treatment: complete biochemical effect in 73.3 %, complete clinical – 66.7%, partial biochemical effect – 20 %, partial clinical effect – 26.6 % of patients.
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