Surgery for Conn's Syndrome and Hyperaldosteronism

What is the Best Adrenal Operation for Conn's Syndrome Tumors?

The correct prone position of a patient undergoing a left Mini Back Scope Adrenalectomy (MBSA). This operation was performed for an 1.2 cm aldosterone-producing adrenal tumor causing Conn’s syndrome and was completed in 23 minutes by Dr. Carling. Without a doubt, the best operation for removing the adrenal tumor that is causing hyperaldosteronism and Conn's syndrome is the Mini Back Scope Adrenalectomy (MBSA). The operation can also be called the Mini Posterior Retroperitoneoscopic Adrenalectomy, because the operation is perfomed with very small scopes that go through the lower, outer back.

The Mini Back Scope Adrenalectomy (MBSA) is the preferred technique in over 95% of adrenal surgery cases, and close to 100% in patients with primary hyperaldosteronism. There are many reasons this technique is preferred over any of the other techniques. The operation is performed with a scope and three small incisions at the small of the back of the patients. The cosmetic outcome is exceptional. This provides a very direct approach to the adrenal gland. The surgeons of the Carling adrenal center popularized this technique and have been using this operative approach for more than 10 years and have more experience than any other center in the United States.

How is a Mini Back Scope Adrenalectomy (MBSA) Performed? The way the operation is done, in experienced hands, leads to no blood loss. The other advantages include that it is faster with less mobilization doing the operation. All these factors lead to less pain for the patient with a shorter length of stay, faster recovery, faster return to normal activities and work. The advantage of less mobilization means that there is less risk of injury to surrounding structures such as the such as the kidney, liver, spleen, pancreas, bowel, or major vessels such as the inferior vena cava; IVC.

Dr Carling's Experience with Conn's Syndrome Surgery. It is believed that Dr. Carling has performed more Mini Back Scope Adrenalectomy (MBSA) for adrenal tumors than any other surgeon in the United States. When performed for hyperaldosteronism (Conn's Syndrome) this operation typically takes Dr. Carling less than 25-35 minutes. By going through the sides of the back the surgeon has a very direct approach to the adrenal gland with the Mini Back Scope Adrenalectomy (MBSA). Dr. Carling popularized this technique while he was Chief of Endocrine Surgery at Yale University Medical School and has been using this operative approach for a decade on hundreds of patients with Conn's syndrome. Note that this is a very advanced technique--surgeons that operate on adrenal glands only a few times per year are not going to offer you this operation, so be careful. If your surgeon is going to operate through the front of the abdomen to get to the adrenal gland located in the very back, then get a second opinion and find a surgeon that does lots of these--your local surgeon does not.

Typical small Band-Aids after a 23-minute Mini Back Scope Adrenalectomy; MBSA for a functional adrenal tumor causing Conn's Syndrome.

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What are the Benefits of Surgery for Conn's Syndrome and Conn's Tumors?

NUMEROUS! There are many benefits from having surgery for Conn's Syndrome and having the adrenal tumor removed. After adrenalectomy (removal of the adrenal gland that has the aldosterone-producing tumor), the patient's high blood pressue is cured (i.e. no more blood pressure medications) in around 50% of patients. The other half of patients will have a significant improvement in their high blood pressure as well as the number of blood pressure drugs they need to take. Factors that have been reported to predict cure after adrenalectomy are: response to spironolactone therapy, young age, short duration of high blood pressure, family history of hypertension, preoperative use of fewer antihypertensive agents, higher ARR and 24-h urinary aldosterone levels. Furthermore, curative surgery for Conn'ss syndrome reduces the risk of target organ damage, that is damage to the heart, blood vessels, kidney, and brain. The patients quality of life is likely to improve, primarily to improvement in anxiety, depressive symptoms, psychological distress, fatigue, lack of energy, reduced activity level, various emotional problems, and body aches.

My Doctor Wants to Treat my Conn's Syndrome with medications. Is That not as Good as Surgery?

NO. Treating primary hyperaldosteronism and Conn's syndrome with medications is only done as a last resort. It is not nearly as safe and effective as surgery. Medications can lower the blood pressure, but does not remove the toxic effects of aldosterone. The aldosterone levels are still high!. The tumor does not disappear by medications. Medications do not fix the problem of target organ damage, that is damage to the heart, blood vessels, kidney, and brain. Adrenalectomy leads to improved quality of life and is also significantly less costly than treating with medications (cost saving of >$20,000 per patient!). Medical treatment is the first choice for Conn's syndrome patients with bilateral disease; however, emerging data suggest that carefully selected patients may better off with surgery. We have two entire pages dedicated to the Mini Back Scope Adrenalectomy (MBSA), and its benefits.

Dr. Carling, Editorial note: Preventive medicine is popular in our culture nowadays, for good reasons. Of course, the idea to prevent future disease is great but sometimes it is easier said than done. There are some great examples, of course. Stop smoking and lose weight if you are obese is likely to prevent future disease. However, having an adrenalectomy for primary hyperaldosteronism may be one of the most effect preventive medical interventions to avoid future devastating diseases.

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