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A Novel Method: Super-selective Adrenal Venous Sampling
Published on: September 15, 2017
Predictors of malignancy in primary aldosteronism
Ayman Agha1, Matthias Hornung, Igors Iesalnieks
1Department of Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
Langenbeck'S Archives of Surgery
|September 20, 2013
Summary
Malignant aldosterone-producing adrenocortical carcinoma (APAC) presents with lower potassium and larger tumors than benign primary aldosteronism (PA). Tumor size >4 cm and high aldosterone/renin ratio predict malignancy, suggesting open adrenalectomy.
Area of Science:
- Endocrinology
- Surgical Oncology
- Oncology
Background:
- Primary aldosteronism (PA) is typically benign but can undergo malignant transformation.
- Aldosterone-producing adrenocortical carcinoma (APAC) is a rare malignant form of PA.
Purpose of the Study:
- To compare clinical and pathological features of APAC with benign PA.
- To identify predictors of malignancy in PA.
Main Methods:
- Retrospective analysis of patients undergoing adrenalectomy for PA.
- Comparison of patients with APAC versus benign PA.
Main Results:
- APAC patients had significantly lower serum potassium (1.7 vs. 3.4 mmol/l) and larger tumors (5.2 vs. 1.8 cm) than benign PA patients.
- APAC patients exhibited a higher aldosterone/renin (A/R) ratio (675 vs. 74).
- All APAC patients experienced disease recurrence postoperatively, unlike most benign PA patients who had minimally invasive surgery.
Conclusions:
- Tumor size >4 cm and a very high A/R ratio are predictors of malignancy in PA.
- Open adrenalectomy is recommended over endoscopic procedures for suspected APAC based on these criteria.
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