Post-op clinical study of PA patients.

I’m waiting for my doctor and his interventional radiologist of choice to stop playing phone tag and actually talk to each other regarding my (hopefully) upcoming AVS. Nothing to update in that department.

I did run across one – one! – study that followed patients who had laparoscopic adrenalectomies for several years after their surgeries. There are lots of facts and figures and charts, and the article can be found here:

Small tumor size as favorable prognostic factor after adrenalectomy in Conn’s adenoma

A few takeaways that are relevant to me (bold is mine):

In the last few years, several studies highlighted the negative effects of aldosterone excess on the heart, the blood vessels, the kidney, and the brain (4, 5), as well as on the glucose metabolism and insulin sensitivity (6, 7), indicating the need for a prompt diagnosis of PA and a correct therapeutic approach.

My doctor seems confident that my insulin resistance issues will resolve post-op, so, this sounded hopeful to me.

It is noteworthy that in the present study we found that small adenomas were responsible for higher aldosterone levels (both in the upright position and postsaline) and for lower serum potassium levels compared with adenoma bigger or equal to 20 mm diameter.

This seems counterintuitive – the bigger the tumor, the more aldosterone, one would think, right? Apparently not. Mine is only 1cm.

In conclusion, in order to avoid inappropriate and prolonged therapy and to prevent irreversible organ damage, an early and correct diagnosis of APA is mandatory, as in a high percentage of cases diagnosis means recovery.

This one has me worried, a little bit. What is early and correct diagnosis, anyway? And what’s this about irreversible organ damage?? The average time to diagnosis in the United States is 6 to 9 years, I’ve heard. The article posits that the maximum time before diagnosis averages a maximum of 6 years in patients whose surgeries were successful. I was diagnosed with hypertension – incorrectly and treated incorrectly, of course – almost 10 years ago, but showed early signs of PA closer to 15 years ago.

Assuming surgery is indicated, none of this is enough to talk me out of trying it. According to this article, I have a lot going in my favor – gender, low BMI, and only moderate (not severe)  hypertension, not to mention the fact that my adenoma is only 1cm.

I’ve talked to a few PA patients who had adrenalectomies and still needed meds post-op. All of them desccribed themselves as sedentary and admitted to needing to lose a few pounds. One of them was over 60; the other two were in their 40s. They all seem to fit the profile of the typical patient whose surgery is not 100% successful – age, activity level, and weight  are all factors that could contribute to essential hypertension, which I am pretty certain that I do not have. Additionally, I think I’ve talked with 3 or 4 others whose surgeries *were* successful and who no longer need any meds.

I only wish I had more to go on than a lone study of 42 patients, combined with the few that I have conversed with personally. Better than nothin’, I guess.

ETA: another full-text article can be found at the link below. This one followed 52 patients.

Factors determining cardiovascular and renal outcomes after adrenalectomy in patients with aldosterone-producing adrenal adenoma.

(Scroll to the bottom, there is a PDF link.)


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