adrenal aldosteronoma resection

Aldosterone is a hormone-regulating hormone secreted by the spheroidal band of the adrenal cortex. Excessive secretion of this hormone can cause clinical syndrome, Conn first reported, known as Conn syndrome. There are many causes of excessive secretion of aldosterone in the adrenal gland, such as primary aldosteronism due to pathological changes in the cortex itself; secondary aldosteronism is stimulated by extra-adrenal lesions, which is secondary. Primary aldosteronism can be caused by tumors or proliferation, with adrenal tumors accounting for 70% to 80% and proliferation accounting for about 20%. The vast majority of tumors are unilateral single adenomas, and no more than 1% of all primary aldosteronism caused by cortical cancer. The cause of proliferation is unclear, the type has specific nodular proliferative type, glucocorticoid curable type, electrolyte hormone controllable type, and there is still a rare type of congenital proliferation related to family inheritance. Myasthenia gravis, hypertension, metabolic alkalosis, and hypokalemia together constitute the performance of this syndrome. Using modern biochemical, endocrine detection technology, imaging inspection technology, the diagnosis rate and positioning accuracy of tumors can reach more than 90%. Proliferative primary aldosteronism, some cortical unilateral or bilateral nodular proliferation, even micro-adenomas, and some diffuse proliferation, and some cortical tissue is normal. The first type of surgical resection can be similar to adenoma, while the second and third types of surgery are unsatisfactory. After adrenal total or subtotal resection, blood pressure drops to normal levels. /3. After unilateral adrenal aldosteronoma surgery, blood pressure dropped to normal within 1 year, and other major symptoms disappeared more than 70%. Cortical cancer has a large tumor, but it can synthesize and secrete other corticosteroids, and it is necessary to perform a diseased adrenalectomy. Therefore, all patients with primary aldosteronism diagnosed with adrenal tumors should be treated with early surgery, and those diagnosed with proliferative type, mainly treated with drugs, given spironolactone (alsoactone, aldactone) 100 ~ 400mg / d, more Can achieve the purpose of controlling symptoms. Treatment of diseases: primary aldosteronism Indication Adrenal aldosteronoma resection is applicable to: 1. Has a typical syndrome manifestations, hypokalemia, low renin activity, high aldosterone; potassium consumption test, body position test are positive results, and spironolactone 400mg / d showed good blocking effect. 2. Imaging examination (B-mode ultrasound imaging, radionuclide scanning, CT, etc.) confirmed that the unilateral adrenal gland showed isolated tumors. 3. With typical syndrome manifestations, although no adrenal tumors are shown, adrenal venography is seen in the tumor defect area, the aldosterone content of the adrenal venous blood on both sides is significantly different, or only the left side catheter blood collection, its value and cavity The value of venous blood is similar, and the right tumor can be determined (compensatory inhibition on the left side). If the left side value is particularly higher than the vena cava value, it can be judged as the left side tumor, which can be used as a surgical exploration indication. This method is currently rarely used. 4. Diagnosis of bilateral nodular type of proliferation, long-term drug treatment symptoms can not be controlled, or can not afford the drug treatment burden. Preoperative preparation For primary aldosteronism caused by adenoma or cortical cancer, preoperative preparation, surgical treatment, preoperative preparation and the indicators that should be achieved are: 1. Spironolactone 60 to 100 mg (microparticles), orally 3 to 4 times a day. After 1 to 2 weeks of treatment, the blood potassium rose to 5-6mmol/L, the nocturia was normal, and the urinary potassium was less than 20mmol/L. 2. Oral potassium salt 6 ~ 9g daily, if necessary, can be intravenously. The daily sodium salt can be appropriately limited to 5 g or less until the potassium level is as high as the above plane, and the urinary potassium and blood sodium are normal. It takes about 1-2 weeks to meet the requirements. 3. With the correction of blood electrolytes and alkalosis, blood pressure can be reduced to normal, and no antihypertensive drugs are needed. If the blood pressure is not satisfactory, and the heart rate is not uniform, appropriate drug control can be added. 4. Unilateral adenoma or cortical cancer does not necessarily require supplementation with corticosteroids before surgery. Multiple bilateral microadenomas or nodular proliferation, bilateral subtotal subtotal resection or total resection, should be treated with corticosteroids, hydrocortisone 100mg, 2 to 3 times a day. 5. Proactive treatment with broad-spectrum antibiotics was started 3 days before surgery. Surgical procedure Large tumors or cortical cancers require more abdominal incision. A unilateral adenoma with a small tumor and a well-defined diagnosis may also be a straight oblique incision or a lumbar incision in the ipsilateral upper abdomen. Tumor localization diagnosis is not clear, or bilateral adrenal gland surgery, can be used in the upper abdominal transverse incision or abdominal longitudinal straight incision through the abdominal surgery, the patient can also be prone position, bilateral incision. In the case of a posterior incision, a Young incision is feasible, or the 11th rib (left) or 12th rib (right) of the back enters the adrenal gland, respectively. If the tumor is on the left side and enters the retroperitoneal space, the kidney and adrenal gland are pulled down and the pancreas is pulled upward. In the case of the right tumor, the kidney is pulled down and separated from the adrenal gland and the tumor, and the liver is pulled upward. When adenoma is removed, the manipulation of the gland should be gentle to avoid edema and oozing, resulting in an unclear boundary between the tumor and the normal gland. After the tumor is removed or the adrenal gland is partially removed, appropriate hemostasis is performed. If a complete adrenalectomy is required, the adrenal vein is ligated and removed as described above. If the pleural cavity has been entered, the diaphragm, the pleura are tightly closed, and the lungs are filled, and the incision is sutured in layers. In the transabdominal bilateral adrenal exploration, if the unilateral nodular proliferation or multiple microadenomas, the lateral adrenal gland can be removed. If it is bilateral, subtotal resection or total resection can be performed according to the indications. If the pathological biopsy of the adrenal gland is normal, the adrenal gland should not be blindly removed. After detailed examination of the adrenal gland or renal parenchyma without tumor, the abdominal cavity is closed and the drug is treated after surgery.

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