Diagnosis And Treatment Of Adrenal Nodular Hyperplastic Hypertension

OBJECTIVE: With the development of the diagnosis technology,more and more hypertensions's causes are found. With the development of B ultrasound ,CT and MRI,more and more adrenal nodular hyperplasia are detected. The adrenal nodular hyperplastic hypertension means that hypertension patient whose adrenal gland has nodular hyperplasia.The clinical data of 31 cases of adrenal nodular hyperplastic hypertension from 1998 to 2006 were retrospectively analyzed. Laparoscopic adrenalectomy was performed in all the 31 cases .We will analyse the degree of blood pressures and other clinical symptoms before operation and after operation. To measure the preoperative and postoperative fig of laboratory examination. Through this way ,we can investigate the diagnosis and treatment of adrenal nodular hyperplastic hypertension. To investigate the diagnosis and treatment of adrenal nodular hyperplastic hypertension. METHODS: There are 14 men and 17 women in all cases.Their average age is 38.8 years old ,from 21 to 69.A11 the cases have hypertension.The average course of disease is 50 months.The serum K+ of 7 cases is below normal . The serum aldosterone of 7 cases is normal. The serum cortisol of 10 cases is above normal. 20 cases are detected by B ultrasound. 26 cases are detected by CT,9 cases are detected by MRI.It is very important to control the blood pressure. Laparoscopic adrenalectomy was performed in all the 31 cases. 30 cases are determined to be adrenal nodular hyperplasia ,lease is determined to be adrenal nodular hyperplasia and adrenal medulla hyperplasia.Among them,22 cases are micronodular hyperplasia , 9 cases are macronodular hyperplasia. The blood pressure of 13 cases drop to the normal one months later,while the blood pressure of 2 cases.6 cases and one case drop to normal after3,6,12 months .We will analyse the degree of blood pressures and other clinical symptoms before operation and after operation. To measure the preoperative and postoperative fig of laboratory examination.To compare the result of B ultrasound ,CT and MRI with the pathology diagnosis. We apply one-factor analysis of variance to analyse the degree of blood pressures before operation and after operation and the preoperative and postoperative fig of laboratory examination. respectively . RESULTS: We found that the patients are young.The average age is 38.8.There are 3 patients below 30years old,while 4 cases above 50 years old. 20 cases(64.5%) are detected by B ultrasound. 26 cases(92.8%) are detected by CT,9 cases(75%) are detected by MRI. All cases's postoperative fig of serum K+, urine potassium, serum aldosterone and serum cortisol become normal except that 2 cases's serum cortisol is still above normal. The cases of respective postoperative clinical symptoms is 26 cases(89.7%), 10 cases( 100%), 10 cases (83.3%), 7 cases (87.5%), 7 cases (100%), 4 cases (100%), 4 cases (100%). Postoperative average contractive pressure drop from 185±25mmHg to 135±15mmHg, average diastolic pressure drop from 116 ± 17mmHg to 88 ± 7mmHg . We apply statistical analysis to the preoperative average contractive pressure and postoperative average contractive pressure 1,3,6,12months later,the same measure to the average diastolic pressure. The P value is less than 0.05. CONCLUSIONS: Resistant hypertension and multi-slice spiral CT is the chief standards of adrenal nodular hyperplastic hypertension. The laboratory examination is secondary to the diagnosis, and it can not directly diagnose the diease. Laparoscopic adrenalectomy is the best treatment of adrenal nodular hyperplastic hypertension.