Re: AVS results data...

[Guest guest]

Go to our AVS form in our files and it will calculate the results. And make it more clear.It looks like they used 2 catheters, and did a before (-5, 0) and after ACTH sampling (+10. +15). Note the big jump in cortisol and aldo after. Looks like major problem is on the right in the before sample. Not as clear after ACTH but still greater by 1.5 on R . Don't recall which side(s) you have bumps on. Thumbnail?Will be interested in what they say. Keep us posted. So if you failed DASH and MCB and other BP meds would consider taking out R side. On Mar 22, 2012, at 4:03 PM, maggiekat7 wrote: One of the NIH doctors just emailed me these data/results of my AVS and said they were waiting on some other labs to give me a full picture and recommendations. I have no idea how to interpret these data...???? (No kidding, it's Greek to me!) adrenal vein sampling aldosterone ng/dlcortisol mcg/dlAldosterone: cortisol ,-5 min right 510.00 495.00 1.03 left 180.00 711.00 0.25 peripheral 6.50 22.30 0.29 0 min right 560.00 472.00 1.19 left 150.00 586.00 0.26 peripheral 6.30 22.00 0.29 ,+10 min right 1700.00 503.00 3.38 left 1100.00 472.00 2.33 peripheral 12.00 24.20 0.50 ,+15 min right 1500.00 422.00 3.55 left 1300.00 580.00 2.24 peripheral 13.00 22.70 0.57

[Guest guest]

Have bumps on both sides...haven't yet tried mcbs. I looked at all the AVS

stuff, but still don't know how to interpret these data. Yes, used 2 catheters,

one in each groin side...what does big jump in aldo and corisol mean?

Yesterday, Dr. M. at NIH said he needed the additional results from

acth/dexamethasone/cortisol blood testing that still is not back yet in order to

give me recommendations....just sent these data and said that. So, I haven't a

clue still. They are having a site visit today, and said they'd get back to me

Mon or Tues. Story of my life these days.

>

> > One of the NIH doctors just emailed me these data/results of my AVS

> > and said they were waiting on some other labs to give me a full

> > picture and recommendations. I have no idea how to interpret these

> > data...???? (No kidding, it's Greek to me!)

> >

> > adrenal vein sampling

> >

> > aldosterone ng/dlcortisol mcg/dlAldosterone: cortisol

> > ,-5 min

> > right 510.00 495.00 1.03

> > left 180.00 711.00 0.25

> > peripheral 6.50 22.30 0.29

> > 0 min

> > right 560.00 472.00 1.19

> > left 150.00 586.00 0.26

> > peripheral 6.30 22.00 0.29

> > ,+10 min

> > right 1700.00 503.00 3.38

> > left 1100.00 472.00 2.33

> > peripheral 12.00 24.20 0.50

> > ,+15 min

> > right 1500.00 422.00 3.55

> > left 1300.00 580.00 2.24

> > peripheral 13.00 22.70 0.57

> >

> >

>

[Guest guest]

My recommendation is that u give a trial of DASH with monitoring or U NA, K and they add MCBs if not at BP and K goals by 2 weeks. Best way to do this is to do chap 9 in the DASH BOOK. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn Mar 23, 2012, at 8:40, maggiekat7 <ljurkovic@...> wrote:

Have bumps on both sides...haven't yet tried mcbs. I looked at all the AVS stuff, but still don't know how to interpret these data. Yes, used 2 catheters, one in each groin side...what does big jump in aldo and corisol mean?

Yesterday, Dr. M. at NIH said he needed the additional results from acth/dexamethasone/cortisol blood testing that still is not back yet in order to give me recommendations....just sent these data and said that. So, I haven't a clue still. They are having a site visit today, and said they'd get back to me Mon or Tues. Story of my life these days.

>

> > One of the NIH doctors just emailed me these data/results of my AVS

> > and said they were waiting on some other labs to give me a full

> > picture and recommendations. I have no idea how to interpret these

> > data...???? (No kidding, it's Greek to me!)

> >

> > adrenal vein sampling

> >

> > aldosterone ng/dlcortisol mcg/dlAldosterone: cortisol

> > ,-5 min

> > right 510.00 495.00 1.03

> > left 180.00 711.00 0.25

> > peripheral 6.50 22.30 0.29

> > 0 min

> > right 560.00 472.00 1.19

> > left 150.00 586.00 0.26

> > peripheral 6.30 22.00 0.29

> > ,+10 min

> > right 1700.00 503.00 3.38

> > left 1100.00 472.00 2.33

> > peripheral 12.00 24.20 0.50

> > ,+15 min

> > right 1500.00 422.00 3.55

> > left 1300.00 580.00 2.24

> > peripheral 13.00 22.70 0.57

> >

> >

>

[Guest guest]

My attending called yesterday with most of their findings. Basically, I am a

complicated case (aren't we all?), and although they can confirm bilateral

disease with more alsosterone secretion on the right, for which they would

normally recommend surgery, they are not recommending it due to complications.

Specifically, they can also confirm that the left adrenal is diseased not only

by overproducing aldosterone, but also high and unsupressable levels of

cortisol. Since the right might be able to be managed by MCB's (they started me

on Epler today, since Spiro increases cortisol levels) and want me to return to

NIH for further evaluation of the cortisol issue. He said if they remove either

adrenal, it would be the left, since they cannot treat the cortisol issue with

meds and my cortisol levels pose potentially more life threatening issues than

the elevated aldosterone. In addition, they found a 5mm solid tumor on my

kidney that they want to monitor. It is an angiomyolipoma, can burst and cause

kidney damage/bleeding. Or just grow and need to be removed. Basically, both

adrenals need to be removed according to guidelines, but they want to evaluate

both further to see if they can leave the lessor of the diseased one, since

taking both, is worse than all of that. All of this is quite sobering to me.

I wish you would stop recommendng the dash to me. I already dash, since 2007.

My husband had an MI then, and we have been quite cardiac/dash compliant ever

since. Furthermore, I HATE salt. However, if you can tell me where I can get

home NA measuring dipsticks to check my levels, I would appreciate that.

I am about to take my first of 25mg. of Epler. Bp this am 163/93...

, if you are reading this, Dr. L will likely call to schedule me today...so

I will let you know...maybe we will meet afterall, wish it were under different

circumstances.

> > >

> > > > One of the NIH doctors just emailed me these data/results of my AVS

> > > > and said they were waiting on some other labs to give me a full

> > > > picture and recommendations. I have no idea how to interpret these

> > > > data...???? (No kidding, it's Greek to me!)

> > > >

> > > > adrenal vein sampling

> > > >

> > > > aldosterone ng/dlcortisol mcg/dlAldosterone: cortisol

> > > > ,-5 min

> > > > right 510.00 495.00 1.03

> > > > left 180.00 711.00 0.25

> > > > peripheral 6.50 22.30 0.29

> > > > 0 min

> > > > right 560.00 472.00 1.19

> > > > left 150.00 586.00 0.26

> > > > peripheral 6.30 22.00 0.29

> > > > ,+10 min

> > > > right 1700.00 503.00 3.38

> > > > left 1100.00 472.00 2.33

> > > > peripheral 12.00 24.20 0.50

> > > > ,+15 min

> > > > right 1500.00 422.00 3.55

> > > > left 1300.00 580.00 2.24

> > > > peripheral 13.00 22.70 0.57

> > > >

> > > >

> > >

> >

> >

>

[Guest guest]

It is possable to remove only the tumor and leave the gland. Not easy or common.

You can try searching for information on this.

> > > >

> > > > > One of the NIH doctors just emailed me these data/results of my AVS

> > > > > and said they were waiting on some other labs to give me a full

> > > > > picture and recommendations. I have no idea how to interpret these

> > > > > data...???? (No kidding, it's Greek to me!)

> > > > >

> > > > > adrenal vein sampling

> > > > >

> > > > > aldosterone ng/dlcortisol mcg/dlAldosterone: cortisol

> > > > > ,-5 min

> > > > > right 510.00 495.00 1.03

> > > > > left 180.00 711.00 0.25

> > > > > peripheral 6.50 22.30 0.29

> > > > > 0 min

> > > > > right 560.00 472.00 1.19

> > > > > left 150.00 586.00 0.26

> > > > > peripheral 6.30 22.00 0.29

> > > > > ,+10 min

> > > > > right 1700.00 503.00 3.38

> > > > > left 1100.00 472.00 2.33

> > > > > peripheral 12.00 24.20 0.50

> > > > > ,+15 min

> > > > > right 1500.00 422.00 3.55

> > > > > left 1300.00 580.00 2.24

> > > > > peripheral 13.00 22.70 0.57

> > > > >

> > > > >

> > > >

> > >

> > >

> >

>

[Guest guest]

I have several small adenomas on both sides; more of which are aldo producing on

right. Not just one big one. Can they remove a bunch of little ones and leave

the gland? If so, I will research and ask. If NIH has this option, I am sure

they would have offered it, so they must not do it. Who's pioneering such?

> > > > >

> > > > > > One of the NIH doctors just emailed me these data/results of my AVS

> > > > > > and said they were waiting on some other labs to give me a full

> > > > > > picture and recommendations. I have no idea how to interpret these

> > > > > > data...???? (No kidding, it's Greek to me!)

> > > > > >

> > > > > > adrenal vein sampling

> > > > > >

> > > > > > aldosterone ng/dlcortisol mcg/dlAldosterone: cortisol

> > > > > > ,-5 min

> > > > > > right 510.00 495.00 1.03

> > > > > > left 180.00 711.00 0.25

> > > > > > peripheral 6.50 22.30 0.29

> > > > > > 0 min

> > > > > > right 560.00 472.00 1.19

> > > > > > left 150.00 586.00 0.26

> > > > > > peripheral 6.30 22.00 0.29

> > > > > > ,+10 min

> > > > > > right 1700.00 503.00 3.38

> > > > > > left 1100.00 472.00 2.33

> > > > > > peripheral 12.00 24.20 0.50

> > > > > > ,+15 min

> > > > > > right 1500.00 422.00 3.55

> > > > > > left 1300.00 580.00 2.24

> > > > > > peripheral 13.00 22.70 0.57

> > > > > >

> > > > > >

> > > > >

> > > >

> > > >

> > >

> >

>

[Guest guest]

Maggie, I read yesterday's posts late last night but was too overwhelmed to respond. I thought you were "wierd" and wondered if I really wanted to go and find out all the informtion like you did! After a good night's sleep and a little research I remembered that "Momma didn't raise no chicken" and it is probably better to know now than finding it on an autopsy!

Besides, I read this: http://www.jstage.jst.go.jp/article/endocrj/58/7/543/_pdf (twice) and determined you are not so "wierd" after all! You simply have one "rare" condition comingled with another "rare" condition that may happen as often as 21% of the time in PTNs with PA according to one study! (Clinicopathological features of primary aldosteronism associated with subclinical Cushing's syndrome).

That certainly raises some interesting questions and I thank you in advance for getting the answers for us: (1)If the average doctor had been treating would they have removed the wrong adrenal? (2) What is the progression? (Which came first, PA or SCS, or did they start at the same time?) That raises more questions: If your good/bad adrenl developed first and was found and removed what would be the treatment when the PA/SCS developed? (3) Assuming they develop independently, If you treat PA with MCBs what is the chances of developing SCS in that adrenal later? This may be even more likely since current evidence is that PA/SCS occurs in "older PTNs". (You're the exception of course! )

I have more questions but don't want to alarm anyone so maybe I'll save them for a week+ and see if NIH has answers.

It would be wonderful to meet up although I share you disappointment with the circumstances. I'd also have my greek interpreter! (I almost hung up on Dr. L. the other day, I have been getting a lot of calls from people looking for donations and didn't recognize 301 area code! I now have him programmed into my phone and when it says "Dr. L." I pay closer attention! No Problems!) Is your knee/leg ready for another trip?

> > > > > > > > > One of the NIH doctors just emailed me these data/results of my AVS > > > > > and said they were waiting on some other labs to give me a full > > > > > picture and recommendations. I have no idea how to interpret these > > > > > data...???? (No kidding, it's Greek to me!)> > > > >> > > > > adrenal vein sampling> > > > >> > > > > aldosterone ng/dlcortisol mcg/dlAldosterone: cortisol> > > > > ,-5 min > > > > > right 510.00 495.00 1.03> > > > > left 180.00 711.00 0.25> > > > > peripheral 6.50 22.30 0.29> > > > > 0 min > > > > > right 560.00 472.00 1.19> > > > > left 150.00 586.00 0.26> > > > > peripheral 6.30 22.00 0.29> > > > > ,+10 min > > > > > right 1700.00 503.00 3.38> > > > > left 1100.00 472.00 2.33> > > > > peripheral 12.00 24.20 0.50> > > > > ,+15 min > > > > > right 1500.00 422.00 3.55> > > > > left 1300.00 580.00 2.24> > > > > peripheral 13.00 22.70 0.57> > > > >> > > > >> > > >> > > > > >> >>

[Guest guest]

Wow, you are good. Great article. Now I don't feel so weird. Thanks...I have

no idea about the other questions you raised. I am overwhelmed trying to digest

all of this. One of the things that is so mind boggling to me is that for years

I have been under neurological care for a tbi that occurred when I was a teen.

First, for years, I leaked spinal fluid, which gave me horrific headaches that

were misdiagnosed as cluster headaches. When finally, correctly diagnosed, I

had the leak patched, no more headaches. since then, I have had memory issues

and auditory processing issues; always attributed to tbi that got significantly

worse a few years ago and was further attributed to tbi and aging. Guess what?

High cortisol causes significant memory issues. Guess what else? Bone issues,

like osteopenia and frequent fractures. I have early osteopenia and frequent

fractures. And insomnia...bingo. So, for me, I would say that the cortisol

issues started prior...maybe 7 years ago? Low K, high BP and hyper aldo

symptomology started within the last 3 years.

> > > > >

> > > > > > One of the NIH doctors just emailed me these data/results of

> my AVS

> > > > > > and said they were waiting on some other labs to give me a

> full

> > > > > > picture and recommendations. I have no idea how to interpret

> these

> > > > > > data...???? (No kidding, it's Greek to me!)

> > > > > >

> > > > > > adrenal vein sampling

> > > > > >

> > > > > > aldosterone ng/dlcortisol mcg/dlAldosterone: cortisol

> > > > > > ,-5 min

> > > > > > right 510.00 495.00 1.03

> > > > > > left 180.00 711.00 0.25

> > > > > > peripheral 6.50 22.30 0.29

> > > > > > 0 min

> > > > > > right 560.00 472.00 1.19

> > > > > > left 150.00 586.00 0.26

> > > > > > peripheral 6.30 22.00 0.29

> > > > > > ,+10 min

> > > > > > right 1700.00 503.00 3.38

> > > > > > left 1100.00 472.00 2.33

> > > > > > peripheral 12.00 24.20 0.50

> > > > > > ,+15 min

> > > > > > right 1500.00 422.00 3.55

> > > > > > left 1300.00 580.00 2.24

> > > > > > peripheral 13.00 22.70 0.57

> > > > > >

> > > > > >

> > > > >

> > > >

> > > >

> > >

> >

>

[Guest guest]

The only one I remember here was Lettie Madden who had a partial last summer.

Don't know how she's doing, I don't think we have heard from her since

September.

As I recall it wasn't in use much exactly for the reasons you experience,

multiple adenomas in one adrenal. As far as I know they can't id. which is

producing until they get it in the lab. I presume the same is true if you have

PA and SCS in the same adrenal. Did they indicate anything different at NIH,

Maggie?

I wonder when they will be able to transplant just an adrenal!

> > > > > >

> > > > > > > One of the NIH doctors just emailed me these data/results of my

AVS

> > > > > > > and said they were waiting on some other labs to give me a full

> > > > > > > picture and recommendations. I have no idea how to interpret these

> > > > > > > data...???? (No kidding, it's Greek to me!)

> > > > > > >

> > > > > > > adrenal vein sampling

> > > > > > >

> > > > > > > aldosterone ng/dlcortisol mcg/dlAldosterone: cortisol

> > > > > > > ,-5 min

> > > > > > > right 510.00 495.00 1.03

> > > > > > > left 180.00 711.00 0.25

> > > > > > > peripheral 6.50 22.30 0.29

> > > > > > > 0 min

> > > > > > > right 560.00 472.00 1.19

> > > > > > > left 150.00 586.00 0.26

> > > > > > > peripheral 6.30 22.00 0.29

> > > > > > > ,+10 min

> > > > > > > right 1700.00 503.00 3.38

> > > > > > > left 1100.00 472.00 2.33

> > > > > > > peripheral 12.00 24.20 0.50

> > > > > > > ,+15 min

> > > > > > > right 1500.00 422.00 3.55

> > > > > > > left 1300.00 580.00 2.24

> > > > > > > peripheral 13.00 22.70 0.57

> > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

Careful how you start the conversation, it took me three tries before I got beyond your first sentence - do you know how long it has been I heard that from a cute young lady?

Get serious, Okay. I didn't expect you to have answers to my questions, they were meant to be thought provoking to get you prepared for your return to NIH. God, I'd love to double-team them down there! My guess is they are advancing to the next phase of DXing and treating PA as testing options becomes better and clearer. That's probably why this study is still ongoing and they were so happy you found them! (Who knows, we may have just found the "Maggie Syndrome", afterall Conn's Syndrome started with one lady as I recall!

I am aware of some of what cortisol does from my gynecomastia and spironolactone "study". Everytime I turn round CPY11B2 (aldosterone) and CPY11B1 (cortisol) pop up. (In Spiro's case the antagonizing of CPY11B2 causes an increase in CPY11B1 which affects Sertonin potentially affecting MDD. Apparently the loop is different depending whether you have Major Depressive Disorder or not!) Now do we have to research the effect if you have TBI? (Wonder if that was considered when they started you on Eplerenone, might be another good reason to reserve Spironolactone for Transgender M2F proceedures IMHO!)

> > > > > >> > > > > > > One of the NIH doctors just emailed me these data/results of> > my AVS> > > > > > > and said they were waiting on some other labs to give me a> > full> > > > > > > picture and recommendations. I have no idea how to interpret> > these> > > > > > > data...???? (No kidding, it's Greek to me!)> > > > > > >> > > > > > > adrenal vein sampling> > > > > > >> > > > > > > aldosterone ng/dlcortisol mcg/dlAldosterone: cortisol> > > > > > > ,-5 min> > > > > > > right 510.00 495.00 1.03> > > > > > > left 180.00 711.00 0.25> > > > > > > peripheral 6.50 22.30 0.29> > > > > > > 0 min> > > > > > > right 560.00 472.00 1.19> > > > > > > left 150.00 586.00 0.26> > > > > > > peripheral 6.30 22.00 0.29> > > > > > > ,+10 min> > > > > > > right 1700.00 503.00 3.38> > > > > > > left 1100.00 472.00 2.33> > > > > > > peripheral 12.00 24.20 0.50> > > > > > > ,+15 min> > > > > > > right 1500.00 422.00 3.55> > > > > > > left 1300.00 580.00 2.24> > > > > > > peripheral 13.00 22.70 0.57> > > > > > >> > > > > > >> > > > > >> > > > >> > > > >> > > >> > >> >>

[Guest guest]

Some food for thought. Everything is not always so linear in their relationships, like just because we gain weight or are fatigued it doesn't mean it is thyroid, or is cortisol, etc, there can be many reasons and even if a lab is off doesn't mean only that lab was the culprit. For example steroids don't cause weight gain - they cause us to eat more - which causes weight gain and we could in theory be aware of this and not give in to the new appetite if we take them. My point is how do you know cortisol is the culprit? It may be a combo or culmination of many of the effects of PA or the TBI.

How did you know it was never low K vs something else until 3 years ago (I now headaches went away when they finally got you patched up)? Were you checking it regularly? Was it ever borderline? And if borderline do we know if they took it right? Were there any symptoms PA like that they naturally attributed to the TBI and spinal leak that may have been underneath it all? Were they good at looking at the big picture or only focused on the spinal leak and past tbi they may have ingored other factors?

The things you talk about also fit a classic calcium deficiency , not just a cortisol issue - and calcium is also the leading electrolyte in our spinal fluid, which isn't a huge amount, but is the most within it. We also don't absorb calcium well if at all, in PA, but because low K is such a stinker, we likely miss alot of low calciums and mags in PA. Your complaints fit the low Ca++ too.

Low K can cause those effects too, and is the low K or something else stressing the body, increasing the cortisol? Is weight one of the biggest complaints or is that not an issue with you? I am curious because every so often cortisol makes the rounds again as the weight culprit in women and I bet skinny, big, in the middle, all of us Americans, most of us maybe, show high cortisol levels because we all a bit on edge with $$ issues, life, elections coming up etc.

Just wonder how much it is actually the cause of problems or just a response to them

How do you even know it was just a cortisol issue?

BTW Dr Gupka was on Conan the other night talking about cortisol and our other stress hormones and related some studies that show that laughing and smiling, even if contrived and fake, lower all of those hormones like cortisol, norepinepherine, etc and increase some of our good ones like serotonin and dopamine. Interesting. I haven't looked it up yet,

From: <jclark24p@...>Subject: Re: AVS results data...hyperaldosteronism Date: Saturday, March 24, 2012, 12:27 PM

> > > > > >> > >

> > > > One of the NIH doctors just emailed me these data/results of> > my AVS> > > > > > > and said they were waiting on some other labs to give me a> > full> > > > > > > picture and recommendations. I have no idea how to interpret> > these> > > > > > > data...???? (No kidding, it's Greek to me!)> > > > > > >> > > > > > > adrenal vein sampling> > > > > > >> > > > > > > aldosterone ng/dlcortisol mcg/dlAldosterone: cortisol> > > > > > > ,-5 min> > > > > > > right 510.00 495.00 1.03> > > > > > > left 180.00 711.00 0.25> > > > > > > peripheral 6.50 22.30 0.29> > > > > > > 0 min> > > > > > > right

560.00 472.00 1.19> > > > > > > left 150.00 586.00 0.26> > > > > > > peripheral 6.30 22.00 0.29> > > > > > > ,+10 min> > > > > > > right 1700.00 503.00 3.38> > > > > > > left 1100.00 472.00 2.33> > > > > > > peripheral 12.00 24.20 0.50> > > > > > > ,+15 min> > > > > > > right 1500.00 422.00 3.55> > > > > > > left 1300.00 580.00 2.24> > > > > > > peripheral 13.00 22.70 0.57> > > > > > >> > > > > > >> > > > > >> > > > >> > > > >> > > >> > >> >>

[Guest guest]

, you are right...other factors are very possible and perhaps I'll never

know...maybe I'm just weird! (My sister always has said so!) Doc said I am one

of his most challenging patients ever...not exactly something I've ever strived

for. And yes, weight has always been an issue for me, but I exercise vigorously

and follow a very strict diet and manage it....it's not easy. Prior to my kids,

I stayed under 140; then got to a high of 203; then after my husband's MI and my

hysterectomy, am down to 155.

> > > > > > >

> > > > > > > > One of the NIH doctors just emailed me these data/results of

> > > my AVS

> > > > > > > > and said they were waiting on some other labs to give me a

> > > full

> > > > > > > > picture and recommendations. I have no idea how to interpret

> > > these

> > > > > > > > data...???? (No kidding, it's Greek to me!)

> > > > > > > >

> > > > > > > > adrenal vein sampling

> > > > > > > >

> > > > > > > > aldosterone ng/dlcortisol mcg/dlAldosterone: cortisol

> > > > > > > > ,-5 min

> > > > > > > > right 510.00 495.00 1.03

> > > > > > > > left 180.00 711.00 0.25

> > > > > > > > peripheral 6.50 22.30 0.29

> > > > > > > > 0 min

> > > > > > > > right 560.00 472.00 1.19

> > > > > > > > left 150.00 586.00 0.26

> > > > > > > > peripheral 6.30 22.00 0.29

> > > > > > > > ,+10 min

> > > > > > > > right 1700.00 503.00 3.38

> > > > > > > > left 1100.00 472.00 2.33

> > > > > > > > peripheral 12.00 24.20 0.50

> > > > > > > > ,+15 min

> > > > > > > > right 1500.00 422.00 3.55

> > > > > > > > left 1300.00 580.00 2.24

> > > > > > > > peripheral 13.00 22.70 0.57

> > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

Not sure if this information will help but is related to to Partial versus total adrenalectomy .

Endocrine Abstracts

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European Congress of Endocrinology 2007

Budapest, Hungary28 April 2007 - 02 May 2007European Society of Endocrinology

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Endocrine Abstracts (2007) 14 P433

Simultaneous bilateral transperitoneal laparoscopic adrenalectomy (SBTLA)

Ferenc Juhasz, Zsolt Kanyari, Ferenc Gyory & Géza Lukacs

University of Debrecen, Surgical Department, Debrecen, Hungary.

Background and Purpose: Laparoscopic adrenalectomy has become the preferred surgical approach to manage adrenal disorders. Bilateral adrenalectomy is performed for diseases that are unresponsive to medical management and, frequently, for neoplastic disease. The aim of this study was to review our experience with laparoscopic bilateral adrenalectomy and to evaluate its safety, efficacy, and outcomes.

Patients and Methods: Between May 1999 and May 2005, four male and four female patients with a mean age of 37 years (range 24–55 years) presented for bilateral adrenalectomy (pheochromocytoma [N=4], Cushing's disease [N=2], malignant neuroendocrine tumor [N=1] and incidentaloma [N=1]. All procedures were performed using a simultan bilateral transperitoneal approach (SBTLA).

Results: Laparoscopic bilateral transperitoneal adrenalectomy was completed simultaneously in eight patients, while in one case the operation was converted due to the neuroendocrine carcinoma localised just behind the confluence of the right renal vein and I.V.C. One tripple tumor was operated by the staged procedure because there was no agreement on a one stage (simultan) operation between the chest surgeon consultant and us. The mean operative time was 189 minutes (range 165–240 minutes), and the mean estimated blood loss was 76 mL (range 55–90 mL). There were no postoperative complications. All patients have been treated postoperatively with daily hydrocortisone and fludrocortisone replacement. After a mean follow-up of 33 months (range 2–45 months), all of the eight patients are alive.

Conclusion: Simultan bilateral transperitoneal laparoscopic adrenalectomy is a safe and effective procedure. Patients are discharged postoperatively in a relatively short time with few complications. Appropriate steroid replacement (if its necessary) and close follow-up allows these patients to return to their regular life style. The meticulous adrenal preserving technic of the LA makes possible to avoid unnecessary hormone supplementation.

Endocrine Abstracts (2007) 14 P433

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> > > > > > > > > > > > > One of the NIH doctors just emailed me these data/results of my AVS > > > > > > > and said they were waiting on some other labs to give me a full > > > > > > > picture and recommendations. I have no idea how to interpret these > > > > > > > data...???? (No kidding, it's Greek to me!)> > > > > > >> > > > > > > adrenal vein sampling> > > > > > >> > > > > > > aldosterone ng/dlcortisol mcg/dlAldosterone: cortisol> > > > > > > ,-5 min > > > > > > > right 510.00 495.00 1.03> > > > > > > left 180.00 711.00 0.25> > > > > > > peripheral 6.50 22.30 0.29> > > > > > > 0 min > > > > > > > right 560.00 472.00 1.19> > > > > > > left 150.00 586.00 0.26> > > > > > > peripheral 6.30 22.00 0.29> > > > > > > ,+10 min > > > > > > > right 1700.00 503.00 3.38> > > > > > > left 1100.00 472.00 2.33> > > > > > > peripheral 12.00 24.20 0.50> > > > > > > ,+15 min > > > > > > > right 1500.00 422.00 3.55> > > > > > > left 1300.00 580.00 2.24> > > > > > > peripheral 13.00 22.70 0.57> > > > > > >> > > > > > >> > > > > >> > > > > > > > > >> > > >> > >> >>