CONN-SYNDROME - 14 YEARS EXPERIENCE FROM 2 EUROPEAN CENTERS

Objective: To evaluate the long term results of adrenalectomy for prim ary hyperaldosteronism. Design: Multicentre retrospective cohort study . Setting: Two university hospitals, UK and Italy. Subjects: 55 patien ts who presented with a mean (SD) preoperative blood pressure of 181/1 10 (21/10) mmHg and a mean (SD) potassium of 2.8 (0.4) mmol/L (range 1 .6-4) during the period October 1978 to October 1992. Inteventions: Un ilateral adrenalectomy, usually by the extraperitoneal approach. Adren alectomy was total in all but nine cases. Main outcome measures: Accur acy of preoperative investigations for the diagnosis and localisation of the lesions, histology, morbidity and mortality, long term outcome (mean follow up 8.8 years). Results: Computed tomography gave a diagno stic accuracy for unilateral lesions of 88%, the postural stimulation test 80%, norcholesterol scintigraphy 84%, and ultrasonography 57%. Hi stological examination showed carcinoma (n = 1), diffuse hyperplasia ( n = 2), nodular hyperplasia (n = 11) including 5 with macronodular hyp erplasia, double adenoma (n = 1) and single adenoma (n = 40). No patie nt died, and 10 developed minor complications. At the latest follow-up 44/52 patients with benign unilateral lesions (85%) have been cured b y adrenalectomy. Conclusions: Our results confirm the safety of the ex traperitoneal approach, and suggest that the improvement in the accura cy of preoperative investigations has allowed a careful selection of p atients with the consequent amelioration of the long term outcome of s urgery for Conn's syndrome. As laparoscopic adrenalectomy is currently advocated as the operation of choice for surgically-remediable minera locorticoid excess, its long term results will have to be comparable w ith these standards.