Kyeong Seon Park1, Jung Hee Kim1, Eu Jeong Ku1, A Ram Hong1, Min Kyong Moon2, Sung Hee Choi2, Chan Soo Shin1, Sang Wan Kim3, Seong Yeon Kim4. 1. Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, KoreaDepartment of Internal MedicineSeoul Metropolitan Government Borame Medical Center, Seoul 156-707, South KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam-city, Gyeonggi-do, South Korea. 2. Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, KoreaDepartment of Internal MedicineSeoul Metropolitan Government Borame Medical Center, Seoul 156-707, South KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam-city, Gyeonggi-do, South Korea Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, KoreaDepartment of Internal MedicineSeoul Metropolitan Government Borame Medical Center, Seoul 156-707, South KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam-city, Gyeonggi-do, South Korea. 3. Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, KoreaDepartment of Internal MedicineSeoul Metropolitan Government Borame Medical Center, Seoul 156-707, South KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam-city, Gyeonggi-do, South Korea Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, KoreaDepartment of Internal MedicineSeoul Metropolitan Government Borame Medical Center, Seoul 156-707, South KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam-city, Gyeonggi-do, South Korea seongyk@plaza.snu.ac.kr swkimmd@snu.ac.kr. 4. Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, KoreaDepartment of Internal MedicineSeoul Metropolitan Government Borame Medical Center, Seoul 156-707, South KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam-city, Gyeonggi-do, South Korea seongyk@plaza.snu.ac.kr swkimmd@snu.ac.kr.
Abstract
OBJECTIVE: Unilateral adrenalectomy is the first-line treatment for aldosterone-producing adenomas (APA). Hyperkalemia after adrenalectomy because of contralateral zona glomerulosa insufficiency has been reported. We investigated clinical risk factors to predict postoperative hyperkalemia in patients with APA undergoing adrenalectomy. DESIGN AND METHODS: This study was conducted by retrospectively reviewing medical records from 2000 to 2012 at Seoul National University Hospital and two other tertiary centers. Data from 124 patients who underwent adrenalectomy were included. Hyperkalemia was defined as serum potassium >5.5 mmol/l. Clinical preoperative risk factors included age, blood pressure, plasma renin activity (PRA), plasma aldosterone concentration (PAC), serum potassium, serum creatinine, glomerular filtration rate (GFR), the mass size on pathology, and mineralocorticoid receptor (MR) antagonist use. RESULTS: Out of 124 patients, 13 (10.5%) developed postoperative hyperkalemia. The incidences of transient and persistent hyperkalemia were 3.2 and 7.3% respectively. Preoperative PRA and PAC were not significantly different in postoperative hyperkalemic patients compared with normokalemic patients. Patients with persistent hyperkalemia were older, had a longer duration of hypertension, larger mass size on pathology, and lower GFR (all P<0.05). The incidence of postoperative hyperkalemia was not different between MR antagonist users and non-users. CONCLUSION: Older age (≥53 years), longer duration of hypertension (≥9.5 years), larger mass size on pathology (≥1.95 cm), and impaired preoperative renal function (GFR <58.2 ml/min) were associated with prolonged postoperative hyperkalemia in patients with APA. MR antagonist use did not prevent postoperative hyperkalemia.
OBJECTIVE: Unilateral adrenalectomy is the first-line treatment for aldosterone-producing adenomas (APA). Hyperkalemia after adrenalectomy because of contralateral zona glomerulosa insufficiency has been reported. We investigated clinical risk factors to predict postoperative hyperkalemia in patients with APA undergoing adrenalectomy. DESIGN AND METHODS: This study was conducted by retrospectively reviewing medical records from 2000 to 2012 at Seoul National University Hospital and two other tertiary centers. Data from 124 patients who underwent adrenalectomy were included. Hyperkalemia was defined as serum potassium >5.5 mmol/l. Clinical preoperative risk factors included age, blood pressure, plasma renin activity (PRA), plasma aldosterone concentration (PAC), serum potassium, serum creatinine, glomerular filtration rate (GFR), the mass size on pathology, and mineralocorticoid receptor (MR) antagonist use. RESULTS: Out of 124 patients, 13 (10.5%) developed postoperative hyperkalemia. The incidences of transient and persistent hyperkalemia were 3.2 and 7.3% respectively. Preoperative PRA and PAC were not significantly different in postoperative hyperkalemicpatients compared with normokalemic patients. Patients with persistent hyperkalemia were older, had a longer duration of hypertension, larger mass size on pathology, and lower GFR (all P<0.05). The incidence of postoperative hyperkalemia was not different between MR antagonist users and non-users. CONCLUSION: Older age (≥53 years), longer duration of hypertension (≥9.5 years), larger mass size on pathology (≥1.95 cm), and impaired preoperative renal function (GFR <58.2 ml/min) were associated with prolonged postoperative hyperkalemia in patients with APA. MR antagonist use did not prevent postoperative hyperkalemia.
Authors: N Wada; Y Shibayama; H Umakoshi; T Ichijo; Y Fujii; K Kamemura; T Kai; R Sakamoto; A Ogo; Y Matsuda; T Fukuoka; M Tsuiki; T Suzuki; M Naruse Journal: J Hum Hypertens Date: 2017-05-25 Impact factor: 3.012
Authors: Kun Kim; Reimar Wernich Thomsen; Sia Kromann Nicolaisen; Lars Pål Hasvold; Eirini Palaka; Henrik Toft Sørensen Journal: BMJ Open Date: 2019-04-01 Impact factor: 2.692
Authors: Ye Seul Yang; Seung Hun Lee; Jung Hee Kim; Jee Hee Yoo; Jung Hyun Lee; Seo Young Lee; A Ram Hong; Dong-Hwa Lee; Jung-Min Koh; Jae Hyeon Kim; Sang Wan Kim Journal: Endocrinol Metab (Seoul) Date: 2021-08-11