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장명철,노동영,윤여규,최국진,오승근,Myung Chul Chang,M,D,Dong-Young Noh,M,D,Yeo- Kyu Youn,M,D,Kuk Jin Choe,M,D,and Seung Keun Oh,M,D 대한갑상선-내분비외과학회 2003 The Koreran journal of Endocrine Surgery Vol.3 No.2
Purpose: Primary aldosteronism due to an adrenal cortical adenoma is a surgically curable disease. However, hypertension is known to persist postoperatively in many patients. The aim of this study was to determine the factors influencing the long-term outcome of blood pressure after an adrenalectomy for a primary aldosteronism and to evaluate the changing pattern of renin and aldosterone. Methods: Forty-two cases of primary aldosteronism, which were operated on and followed up at the Department of Surgery, Seoul National University Hospital from January 1986 to June 2001 were included in this study. The subjects were classified into a normotensive group and a hypertensive group and the two groups were compared according to the clinical, biochemical and pathological parameters. Results: After surgery, the aldosterone concentration was decreased and the plasma renin activity was increased. During a mean follow-up period of 28 months, 31 patients (73.8%) had a normal blood pressure without an antihypertensive treatment. The significant risk factors for persistent hypertension were a family history of hypertension, a long duration of preoperative hypertension, a poor response of preoperative spironolactone. The hypertensive group had a higher level of postoperative plasma renin activity and an aldosterone concentration in the long-term follow-up period after surgery. Conclusion: A family history of hypertension, the duration of hypertension and the response to spironolactone were factors influencing persistent hypertension after surgery for a primary aldosteronism. A high level of plasma renin activity and aldosterone during the follow-up period is related to the persistent hypertension. Therefore, early detection and surgery for a primary aldosteronism would reduce the preoperative cardiovascular changes and improve the postoperative outcome. (Korean J Endocrine Surg 2003;3:141-146)
김훈엽(Hoon Yub Kim),장명철(Myung Chul Chang),노동영(Dong-Young Noh),윤여규(Yeo-Kyu Youn),오승근(Seung Keun Oh) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.73 No.2
Purpose: Despite of recent advances in the resolution of computed tomography (CT) and magnetic resonance imaging (MRI), there are different kinds of peri-adrenal retroperitoneal tumors that can hardly be differentiated from adrenal tumor preoperatively. By reviewing certain tumors and their characteristics, we may increase the preoperative diagnostic accuracy and so may perform the proper operation when facing this situation. Methods: We retrospectively reviewed fourteen cases of non-adrenal origin retroperitoneal tumors that were preoperatively diagnosed as adrenal tumors during a seven-year period at Seoul National Universiry Hospital. Results: The fourteen retroperitoneal tumors preoperatively misdiagnosed as adrenal tumors were extra-adrenal ganglioneuroma (6 cases), schwannoma (2 cases), retroperitoneal paraganglioma (1 case), bronchogenic cyst (2 cases), Castleman’s disease (1 case), idiopathic retroperitoneal fibrosis (1 case) and leiomyosarcoma (1 case). All of them were large (>6 ㎝), and most were solid. Conclusion: For the correct preoperative diagnosis and appropriate operation of peri-adrenal retroperitoneal tumors, and especially when the tumors are large and solid, the disease entities mentioned above should be excluded, and the application of additional diagnostic measures such as preoperative fine needle aspiration cytologic examination or biopsy, endoscopic ultrasound (EUS), intraoperative frozen biopsy, laparoscopic ultrasound (LUS), as well as preoperative CT and MRI, should be considered when the diagnosis is not conclusive.