An Analytical Study Of Clinical Characteristics Of Adrenal Diseases And The Surgical Treatment With Laparoscopy

Objective: To investigate the prevalence and clinical characteristics of surgical adrenal diseases, and to explore the effectiveness and safety of laparoscopic adrenalectomy for improving the diagnostic and therapeutic efficacy of adrenal diseases.Patients and Methods: A retrospective analysis of clinical data of patients with adrenal diseases confirmed pathologically who received operation between 2003 and 2010 in surgical ward in the department of Urology of the third hospital of Hebei Medical University. Statistics of characteristics of surgical adrenal diseases, including the total number of cases, the age of onset, classification, sex and constituent ratios of surgical adrenal diseases. Analyzing clinical data of patients, including clinical manifestations, laboratory and imaging features, and the diagnostic methods for adrenal diseases. Then investigating the application of laparoscopy in the adrenal diseases through comparing the number of laparoscopic and open operations and analyzing the successful adrenal surgery and complications after operations. All patients were followed up according to their address and telephone number.Results: A total of 133 cases of adrenal diseases were treated in the department of urology of the third hospital of Hebei Medical University between 2003 and 2010, with more female patients than male patients (F : M = 1 : 1.29). Of the 133 patients, all aged from 16 to 74 years old (average 45.36±13.45 years old), and 97 (72.93%) aged between 30 and 60 years old. Primary aldosteronism is the most common type of the three adrenal diseases (33.9%), followed by hyper-catecholamine (20.30%), and hypercortisolism has the lowest prevalence rate (11.28%). Primary aldosteronism and hypercortisolism is more common in female patients than in male, while hyper-catecholamine is the same. Symptoms varied with the types of adrenal diseases. The correct diagnoses of adrenal diseases depended on a comprehensive analysis of clinical manifestation, laboratorial examination and imaging findings. Of the 55 patients with primary aldosteronism, 45 (81.82%) had hypertension, 44 (80%) had hypokalemia, and 48 was examined by endocrine test with 32 cases having increased aldosterone levels in blood and urine or having decreased levels of serum rennin. All 15 patients displayed characteristic expressions of hypercortisolism including signs like moon face, central obesity and sanguineous temperament, and had increased serum cortisol levels. Of 27 patients with hyper-catecholamine, 26 (96.30%) had different levels of hypertension, varying largely from 140 to 290mmHg for diastolic pressure and from 90 to 170mmHg for systolic pressure, only 1 had normal blood pressure, 21 had a serum catecholamine test with 14 having positive results and 13 had a urine catecholamine test with 5 doing. Moreover, 19 cases (14.3%), who didn't display any symptom, were found having occupancy lesions in adrenal glands in physical examination. CT examine was used for location diagnosis for all of the 133 patients. In this study, all of the 125 operative patients received retroperitoneal laparoscopic adrenalectomy with 123 successful operations (98.4%) and 9 implications (7.32%), and 2 patients were received open surgeries because of the serious bleeding during laparoscopic surgeries. Of 123 successful operations, 2 were operated on unilateral adrenal and 121 on bilateral adrenals, 72 were total adrenalectomy and 49 were regional. There was no significant difference on operation time and complications between total adrenalectomy group and partial adrenalectomy group, but were on intraoperative blood loss. During the follow-up period (1 month to 6 years) after operation, no death and recurrence were observed, and 56 patients'blood pressure returned to normal level. None of patients require hormone replacement therapy 1 month post-operation.Conclusions: Surgical adrenal diseases were more common in female patients than in male. Most of the patients were 30-60 years-old. In the 3 common types of adrenal diseases, primary aldosteronism was the most common, followed by hyper-catecholamine and then hypercortisolism. The correct diagnoses of adrenal diseases not only depended on clinical manifestations, but also on B-ultrasound, CT imaging and endocrine tests. Surgery is the primary method of treatment of adrenal diseases.Adequate pre-operation preparation is the key to success, which also could reduce the risks of operation. Laparoscopic adrenalectomy has become the gold standard for treatment of adrenal tumors.