Endocrine Abstracts

Objective: We reviewed clinical and biochemical characteristics and post-operative outcomes in patients undergoing surgery for PHA in UHS between January 2014 and June 2022 (8.5-year period).

Results: 17 patients (41% female, mean age 45y) underwent adrenalectomy for PHA during this period. 5/17 (29%) required admissions related to PHA, 7/17 had blood pressure (BP) of ≥ 200 mmol/Hg, 11/17 (65%) potassium ≤3 mmol/l, 5/17 required ≥ 4 BP agents. 3/17 (18%) described significant nocturnal polyuria. All had unilateral disease radiologically. Confirmatory testing was performed in 12/17 (70%), adrenal venous sampling (AVS) in 11/17 (65%) of which 6/11 had successful bilateral cannulation. 10/17 (59%) had 1 mg ODST, of which 3/10 had co-secreting lesions.

Histology: 13/17 (76%) had single adenoma. 1/17 had normal histology and 3/17 a dominant nodule with background adrenal hyperplasia all of whom lateralised with AVS and experienced full BP and potassium normalisation.

Post-operative outcomes: All achieved normokalaemia. 12/17 (70%) achieved full normalisation of BP. 3/17 developed post-operative hypotension. 5/17 had partial BP response with reduction in number of BP medications (mean pre-op:4.2, mean post-op:1.6) and no readmissions. All partial responders had single adenoma on histology and neither underwent AVS (3/5) or had unsuccessful AVS (2/5).

Conclusion: In this small cohort we observed higher rates of complete clinical response to that reported in literature, likely due to patient characteristics such as younger age, shorter duration of PHA and severe disease. None of the partial responders lateralised pre-operatively and increased availability of lateralisation investigations such as AVS and ¹¹C Metomidate PET-CT scanning can increase success rates. 1 mg ODST should be checked in all to help with peri-operative planning. Lack post-operative ARR testing precluded assessment of biochemical cure. The post operative ARR should be considered in all, especially in those with partial surgical response to help guide medical therapy.