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Horm Metab Res 2012; 44(03): 221-227
DOI: 10.1055/s-0031-1299681
Review
© Georg Thieme Verlag KG Stuttgart · New York

Outcomes of Adrenalectomy in Patients with Unilateral Primary Aldosteronism: A Review

O. Steichen
1   Université Pierre et Maris Curie – Paris 6, faculté de médecine, Paris, France; Assistance Publique-Hôpitaux de Paris, ­Hôpital Tenon, Department of ­Internal Medicine, Paris, France
,
F. Zinzindohoué
2   Université Paris Descartes, faculté de médecine, Paris, France
3   Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges ­Pompidou, Department of Visceral Surgery, Paris, France
,
P.-F. Plouin
2   Université Paris Descartes, faculté de médecine, Paris, France
4   Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges ­Pompidou, Hypertension unit, Paris, France
,
L. Amar
2   Université Paris Descartes, faculté de médecine, Paris, France
5   INSERM U970, Cardiovascular Research Center, Paris, France
6   Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges ­Pompidou, Department of Genetics, Paris, France
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Publikationsverlauf

received 26. September 2011

accepted 01. Dezember 2011

Publikationsdatum:
13. Januar 2012 (online)

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Abstract

Aldosterone hypersecretion in primary aldosteronism is unilateral (aldosterone producing adenoma and primary unilateral hyperplasia) or bilateral (idiopathic adrenal hyperplasia). Lapa­roscopic adrenalectomy is nowadays the preferred approach to treat patients with unilateral primary aldosteronism. We review the outcomes of this intervention in recently published series. Laparoscopic adrenalectomy has a morbidity of 5–14%, mortality below 1%, and a mean hospital stay around 3 days. It generally results in the normalization of aldosterone secretion and in a large decrease of blood pressure and antihypertensive medication, but normotension without treatment is only achieved in 42% of all cases. Normotension following adrenalectomy is more likely in young and lean women with recent low grade hypertension than in obese men with long-standing high grade hypertension or a family history of hypertension. However, individual prediction of the blood pressure outcome is not accurate and predictors of hypertension cure should not be used to select patients for surgery. Age, associated health conditions and preferences of the patient are more relevant to this end.

Key words

hyperaldosteronism - adrenalectomy - minimally invasive surgical procedures - treatment outcome - prognosis - spironolactone
 

  • References

  • 1 Amar L, Plouin PF, Steichen O. Aldosterone-producing adenoma and other surgically correctable forms of primary aldosteronism. Orphanet J Rare Dis 2010; 5: 9
    CrossrefPubMedSuche in Google Scholar
  • 2 Omura M, Sasano H, Saito J, Yamaguchi K, Kakuta Y, Nishikawa T. Clinical characteristics of aldosterone-producing microadenoma, macroadenoma, and idiopathic hyperaldosteronism in 93 patients with primary aldosteronism. Hypertens Res 2006; 29: 883-889
    CrossrefPubMedSuche in Google Scholar
  • 3 Connell JM, MacKenzie SM, Freel EM, Fraser R, Davies E. A lifetime of aldosterone excess: long-term consequences of altered regulation of aldosterone production for cardiovascular function. Endocr Rev 2008; 29: 133-154
    Suche in Google Scholar
  • 4 Gagner M, Lacroix A, Bolte E. Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med 1992; 327: 1033
    CrossrefPubMedSuche in Google Scholar
  • 5 Chavez-Rodriguez J, Pasieka JL. Adrenal lesions assessed in the era of laparoscopic adrenalectomy: a modern day series. Am J Surg 2005; 189: 581-585 discussion 585–586
    CrossrefPubMedSuche in Google Scholar
  • 6 Quinkler M, Stewart PM. Treatment of primary aldosteronism. Best Pract Res Clin Endocrinol Metab 2010; 24: 923-932
    CrossrefPubMedSuche in Google Scholar
  • 7 Assalia A, Gagner M. Laparoscopic adrenalectomy. Br J Surg 2004; 91: 1259-1274
    CrossrefPubMedSuche in Google Scholar
  • 8 Naya Y, Nagata M, Ichikawa T, Amakasu M, Omura M, Nishikawa T, Yamaguchi K, Ito H. Laparoscopic adrenalectomy: comparison of transperitoneal and retroperitoneal approaches. BJU Int 2002; 90: 199-204
    CrossrefPubMedSuche in Google Scholar
  • 9 Berber E, Tellioglu G, Harvey A, Mitchell J, Milas M, Siperstein A. Comparison of laparoscopic transabdominal lateral versus posterior retroperitoneal adrenalectomy. Surgery 2009; 146: 621-625 discussion 625–626
    CrossrefPubMedSuche in Google Scholar
  • 10 Brunt LM. Minimal access adrenal surgery. Surg Endosc 2006; 20: 351-361
    CrossrefPubMedSuche in Google Scholar
  • 11 Yuge K, Miyajima A, Hasegawa M, Miyazaki Y, Maeda T, Takeda T, Takeda A, Miyashita K, Kurihara I, Shibata H, Kikuchi E, Oya M. Initial experience of transumbilical laparoendoscopic single-site surgery of partial adrenalectomy in patient with aldosterone-producing adenoma. BMC Urol 2010; 10: 19
    CrossrefPubMedSuche in Google Scholar
  • 12 Cadiere GB, Himpens J, Germay O, Izizaw R, Degueldre M, Vandromme J, Capelluto E, Bruyns J. Feasibility of robotic laparoscopic surgery: 146 cases. World J Surg 2001; 25: 1467-1477
    PubMedSuche in Google Scholar
  • 13 Hyams ES, Stifelman MD. The role of robotics for adrenal pathology. Curr Opin Urol 2009; 19: 89-96
    CrossrefPubMedSuche in Google Scholar
  • 14 Ramirez-Plaza CP, Gallego Perales JL, Camero NM, Rodriguez-Canete A, Bondia-Navarro JA, Santoyo-Santoyo J. Outpatient laparoscopic adrenalectomy: a new step ahead. Surg Endosc 2011; 25: 2570-2573
    CrossrefPubMedSuche in Google Scholar
  • 15 Walz MK, Alesina PF, Wenger FA, Deligiannis A, Szuczik E, Petersenn S, Ommer A, Groeben H, Peitgen K, Janssen OE, Philipp T, Neumann HP, Schmid KW, Mann K. Posterior retroperitoneoscopic adrenalectomy – results of 560 procedures in 520 patients. Surgery 2006; 140: 943-948 discussion 948–950
    CrossrefPubMedSuche in Google Scholar
  • 16 Tessier DJ, Iglesias R, Chapman WC, Kercher K, Matthews BD, Gorden DL, Brunt LM. Previously unreported high-grade complications of adrenalectomy. Surg Endosc 2009; 23: 97-102
    CrossrefPubMedSuche in Google Scholar
  • 17 Boulkroun S, Samson-Couterie B, Dzib JF, Lefebvre H, Louiset E, Amar L, Plouin PF, Lalli E, Jeunemaitre X, Benecke A, Meatchi T, Zennaro MC. Adrenal cortex remodeling and functional zona glomerulosa hyperplasia in primary aldosteronism. Hypertension 2010; 56: 885-892
    Suche in Google Scholar
  • 18 Omura M, Sasano H, Fujiwara T, Yamaguchi K, Nishikawa T. Unique cases of unilateral hyperaldosteronemia due to multiple adrenocortical micronodules, which can only be detected by selective adrenal venous sampling. Metabolism 2002; 51: 350-355
    CrossrefPubMedSuche in Google Scholar
  • 19 Ishidoya S, Ito A, Sakai K, Satoh M, Chiba Y, Sato F, Arai Y. Laparoscopic partial versus total adrenalectomy for aldosterone producing adenoma. J Urol 2005; 174: 40-43
    Suche in Google Scholar
  • 20 Kaye DR, Storey BB, Pacak K, Pinto PA, Linehan WM, Bratslavsky G. Partial adrenalectomy: underused first line therapy for small adrenal tumors. J Urol 2010; 184: 18-25
    CrossrefPubMedSuche in Google Scholar
  • 21 Fu B, Zhang X, Wang GX, Lang B, Ma X, Li HZ, Wang BJ, Shi TP, Ai X, Zhou HX, Zheng T. Long-term results of a prospective, randomized trial comparing retroperitoneoscopic partial versus total adrenalectomy for aldosterone producing adenoma. J Urol 2011; 185: 1578-1582
    Suche in Google Scholar
  • 22 Minowada S, Fujimura T, Takahashi N, Kishi H, Hasuo K, Minami M. Computed tomography-guided percutaneous acetic acid injection therapy for functioning adrenocortical adenoma. J Clin Endocrinol Metab 2003; 88: 5814-5817
    CrossrefPubMedSuche in Google Scholar
  • 23 Hokotate H, Inoue H, Baba Y, Tsuchimochi S, Nakajo M. Aldosteronomas: experience with superselective adrenal arterial embolization in 33 cases. Radiology 2003; 227: 401-406
    CrossrefPubMedSuche in Google Scholar
  • 24 Liu SY, Ng EK, Lee PS, Wong SK, Chiu PW, Mui WL, So WY, Chow FC. Radiofrequency ablation for benign aldosterone-producing adenoma: a scarless technique to an old disease. Ann Surg 2010; 252: 1058-1064
    CrossrefPubMedSuche in Google Scholar
  • 25 The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V) . Arch Intern Med 1993; 153: 154-183
    CrossrefPubMedSuche in Google Scholar
  • 26 Mulatero P, Stowasser M, Loh KC, Fardella CE, Gordon RD, Mosso L, Gomez-Sanchez CE, Veglio F, Young Jr WF. Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. J Clin Endocrinol Metab 2004; 89: 1045-1050
    Suche in Google Scholar
  • 27 Sawka AM, Young WF, Thompson GB, Grant CS, Farley DR, Leibson C, van Heerden JA. Primary aldosteronism: factors associated with normalization of blood pressure after surgery. Ann Intern Med 2001; 135: 258-261
    CrossrefPubMedSuche in Google Scholar
  • 28 Lumachi F, Ermani M, Basso SM, Armanini D, Iacobone M, Favia G. Long-term results of adrenalectomy in patients with aldosterone-producing adenomas: multivariate analysis of factors affecting unresolved hypertension and review of the literature. Am Surg 2005; 71: 864-869
    PubMedSuche in Google Scholar
  • 29 Satoh F, Abe T, Tanemoto M, Nakamura M, Abe M, Uruno A, Morimoto R, Sato A, Takase K, Ishidoya S, Arai Y, Suzuki T, Sasano H, Ishibashi T, Ito S. Localization of aldosterone-producing adrenocortical adenomas: significance of adrenal venous sampling. Hypertens Res 2007; 30: 1083-1095
    CrossrefPubMedSuche in Google Scholar
  • 30 Pang TC, Bambach C, Monaghan JC, Sidhu SB, Bune A, Delbridge LW, Sywak MS. Outcomes of laparoscopic adrenalectomy for hyperaldosteronism. ANZ J Surg 2007; 77: 768-773
    CrossrefPubMedSuche in Google Scholar
  • 31 Rossi GP, Bolognesi M, Rizzoni D, Seccia TM, Piva A, Porteri E, Tiberio GA, Giulini SM, Agabiti-Rosei E, Pessina AC. Vascular remodeling and duration of hypertension predict outcome of adrenalectomy in primary aldosteronism patients. Hypertension 2008; 51: 1366-1371
    CrossrefPubMedSuche in Google Scholar
  • 32 Letavernier E, Peyrard S, Amar L, Zinzindohoue F, Fiquet B, Plouin PF. Blood pressure outcome of adrenalectomy in patients with primary hyperaldosteronism with or without unilateral adenoma. J Hypertens 2008; 26: 1816-1823
    Suche in Google Scholar
  • 33 Zarnegar R, Lee J, Brunaud L, Lindsay S, Kebebew E, Clark OH, Duh QY. Good blood pressure control on antihypertensives, not only response to spironolactone, predicts improved outcome after adrenalectomy for aldosteronoma. Surgery 2007; 142: 921-929 discussion 921–929
    CrossrefPubMedSuche in Google Scholar
  • 34 Zarnegar R, Young Jr WF, Lee J, Sweet MP, Kebebew E, Farley DR, Thompson GB, Grant CS, Clark OH, Duh QY. The aldosteronoma resolution score: predicting complete resolution of hypertension after adrenalectomy for aldosteronoma. Ann Surg 2008; 247: 511-518
    CrossrefPubMedSuche in Google Scholar
  • 35 Walz MK, Gwosdz R, Levin SL, Alesina PF, Suttorp AC, Metz KA, Wenger FA, Petersenn S, Mann K, Schmid KW. Retroperitoneoscopic adrenalectomy in Conn’s syndrome caused by adrenal adenomas or nodular hyperplasia. World J Surg 2008; 32: 847-853
    Suche in Google Scholar
  • 36 White ML, Gauger PG, Doherty GM, Cho KJ, Thompson NW, Hammer GD, Miller BS. The role of radiologic studies in the evaluation and management of primary hyperaldosteronism. Surgery 2008; 144: 926-933 discussion 933
    CrossrefPubMedSuche in Google Scholar
  • 37 Mourad JJ, Girerd X, Milliez P, Lopez-Sublet M, Lejeune S, Safar ME. Urinary aldosterone-to-active-renin ratio: a useful tool for predicting resolution of hypertension after adrenalectomy in patients with aldosterone-producing adenomas. Am J Hypertens 2008; 21: 742-747
    CrossrefPubMedSuche in Google Scholar
  • 38 Chiou TT, Chiang PH, Fuh M, Liu RT, Lee WC, Lee WC, Ng HY, Tsai YC, Chuang FR, Huang CC, Lee CT. Factors determining cardiovascular and renal outcomes after adrenalectomy in patients with aldosterone-producing adrenal adenoma. Tohoku J Exp Med 2009; 218: 17-24
    CrossrefPubMedSuche in Google Scholar
  • 39 Campagnacci R, Crosta F, De Sanctis A, Baldarelli M, Giacchetti G, Paganini AM, Coletta M, Guerrieri M. Long-term results of laparoscopic adrenalectomy for primary aldosteronism. J Endocrinol Invest 2009; 32: 57-62
    PubMedSuche in Google Scholar
  • 40 Wu VC, Chueh SC, Chang HW, Lin LY, Liu KL, Lin YH, Ho YL, Lin WC, Wang SM, Huang KH, Hung KY, Kao TW, Lin SL, Yen RF, Chen YM, Hsieh BS, Wu KD. Association of kidney function with residual hypertension after treatment of aldosterone-producing adenoma. Am J Kidney Dis 2009; 54: 665-673
    CrossrefPubMedSuche in Google Scholar
  • 41 Murashima M, Trerotola SO, Fraker DL, Han D, Townsend RR, Cohen DL. Adrenal venous sampling for primary aldosteronism and clinical outcomes after unilateral adrenalectomy: a single-center experience. J Clin Hypertens (Greenwich) 2009; 11: 316-323
    CrossrefPubMedSuche in Google Scholar
  • 42 Tresallet C, Salepcioglu H, Godiris-Petit G, Hoang C, Girerd X, Menegaux F. Clinical outcome after laparoscopic adrenalectomy for primary hyperaldosteronism: the role of pathology. Surgery 2010; 148: 129-134
    CrossrefPubMedSuche in Google Scholar
  • 43 Wang B, Zhang G, Ouyang J, Deng X, Shi T, Ma X, Li H, Ju Z, Wang C, Wu Z, Liu S, Zhang X. Association of DNA polymorphisms within the CYP11B2/CYP11B1 locus and postoperative hypertension risk in the patients with aldosterone-producing adenomas. Urology 2010; 76: e1011-e1017 e1018
    PubMedSuche in Google Scholar
  • 44 Waldmann J, Maurer L, Holler J, Kann PH, Ramaswamy A, Bartsch DK, Langer P. Outcome of Surgery for Primary Hyperaldosteronism. World J Surg 2011; 35: 2422-2427
    CrossrefPubMedSuche in Google Scholar
  • 45 Ishidoya S, Kaiho Y, Ito A, Morimoto R, Satoh F, Ito S, Ishibashi T, Nakamura Y, Sasano H, Arai Y. Single-center outcome of laparoscopic unilateral adrenalectomy for patients with primary aldosteronism: lateralizing disease using results of adrenal venous sampling. Uro­logy 2011; 78: 68-73
    PubMedSuche in Google Scholar
  • 46 Stowasser M, Gordon RD. Primary aldosteronism – careful investigation is essential and rewarding. Mol Cell Endocrinol 2004; 217: 33-39
    CrossrefPubMedSuche in Google Scholar
  • 47 Kline GA, Harvey A, Jones C, Hill MH, So B, Scott-Douglas N, Pasieka JL. Adrenal vein sampling may not be a gold-standard diagnostic test in primary aldosteronism: final diagnosis depends upon which interpretation rule is used. Variable interpretation of adrenal vein sampling. Int Urol Nephrol 2008; 40: 1035-1043
    CrossrefPubMedSuche in Google Scholar
  • 48 Lau JH, Sze WC, Reznek RH, Matson M, Sahdev A, Carpenter R, Berney DM, Akker SA, Chew SL, Grossman AB, Monson JP, Drake WM. A prospective Evaluation Of Postural Stimulation Testing, Computed Tomography And Adrenal Vein Sampling In The Differential Diagnosis Of Primary Aldosteronism. Clin Endocrinol (Oxf) 2011; Sep 7 [Epub ahead of print]
    PubMedSuche in Google Scholar
  • 49 Ghose RP, Hall PM, Bravo EL. Medical management of aldosterone-producing adenomas. Ann Intern Med 1999; 131: 105-108
    PubMedSuche in Google Scholar
  • 50 Yoshitomi Y, Nishikimi T, Abe H, Yoshiwara F, Suzuki T, Ashizawa A, Nagata S, Kuramochi M, Matsuoka H, Omae T. Comparison of changes in cardiac structure after treatment in secondary hypertension. Hypertension 1996; 27: 319-323
    CrossrefPubMedSuche in Google Scholar
  • 51 Rossi GP, Sacchetto A, Visentin P, Canali C, Graniero GR, Palatini P, Pessina AC. Changes in left ventricular anatomy and function in hypertension and primary aldosteronism. Hypertension 1996; 27: 1039-1045
    Suche in Google Scholar
  • 52 Giacchetti G, Ronconi V, Turchi F, Agostinelli L, Mantero F, Rilli S, Boscaro M. Aldosterone as a key mediator of the cardiometabolic syndrome in primary aldosteronism: an observational study. J Hypertens 2007; 25: 177-186
    Suche in Google Scholar
  • 53 Lin YH, Huang KH, Lee JK, Wang SM, Yen RF, Wu VC, Chung SD, Liu KL, Chueh SC, Lin LY, Ho YL, Chen MF, Wu KD. Factors influencing left ventricular mass regression in patients with primary aldosteronism post adrenalectomy. J Renin Angiotensin Aldosterone Syst 2011; 12: 48-53
    CrossrefPubMedSuche in Google Scholar
  • 54 Catena C, Colussi G, Lapenna R, Nadalini E, Chiuch A, Gianfagna P, Sechi LA. Long-term cardiac effects of adrenalectomy or mineralocorticoid antagonists in patients with primary aldosteronism. Hypertension 2007; 50: 911-918
    Suche in Google Scholar
  • 55 Rossi GP, Sacchetto A, Pavan E, Palatini P, Graniero GR, Canali C, Pessina AC. Remodeling of the left ventricle in primary aldosteronism due to Conn’s adenoma. Circulation 1997; 95: 1471-1478
    Suche in Google Scholar
  • 56 Catena C, Colussi G, Nadalini E, Chiuch A, Baroselli S, Lapenna R, Sechi LA. Cardiovascular outcomes in patients with primary aldosteronism after treatment. Arch Intern Med 2008; 168: 80-85
    Suche in Google Scholar
  • 57 Ribstein J, Du Cailar G, Fesler P, Mimran A. Relative glomerular hyperfiltration in primary aldosteronism. J Am Soc Nephrol 2005; 16: 1320-1325
    Suche in Google Scholar
  • 58 Sechi LA, Novello M, Lapenna R, Baroselli S, Nadalini E, Colussi GL, Catena C. Long-term renal outcomes in patients with primary aldosteronism. JAMA 2006; 295: 2638-2645
    Suche in Google Scholar
  • 59 Catena C, Colussi G, Nadalini E, Chiuch A, Baroselli S, Lapenna R, Sechi LA. Relationships of plasma renin levels with renal function in patients with primary aldosteronism. Clin J Am Soc Nephrol 2007; 2: 722-731
    Suche in Google Scholar
  • 60 Sechi LA, Di Fabio A, Bazzocchi M, Uzzau A, Catena C. Intrarenal hemodynamics in primary aldosteronism before and after treatment. J Clin Endocrinol Metab 2009; 94: 1191-1197
    Suche in Google Scholar
  • 61 Reincke M, Rump LC, Quinkler M, Hahner S, Diederich S, Lorenz R, Seufert J, Schirpenbach C, Beuschlein F, Bidlingmaier M, Meisinger C, Holle R, Endres S. Risk factors associated with a low glomerular filtration rate in primary aldosteronism. J Clin Endocrinol Metab 2009; 94: 869-875
    Suche in Google Scholar
  • 62 Pimenta E, Gordon RD, Ahmed AH, Cowley D, Robson D, Kogovsek C, Stowasser M. Unilateral adrenalectomy improves urinary protein excretion but does not abolish its relationship to sodium excretion in patients with aldosterone-producing adenoma. J Hum Hypertens 2011; 25: 592-599
    CrossrefPubMedSuche in Google Scholar
  • 63 Wu VC, Kuo CC, Wang SM, Liu KL, Huang KH, Lin YH, Chu TS, Chang HW, Lin CY, Tsai CT, Lin LY, Chueh SC, Kao TW, Chen YM, Chiang WC, Tsai TJ, Ho YL, Lin SL, Wang WJ, Wu KD. Primary aldosteronism: changes in cystatin C-based kidney filtration, proteinuria, and renal duplex indices with treatment. J Hypertens 2011; 29: 1778-1786
    CrossrefPubMedSuche in Google Scholar
  • 64 Wu VC, Yang SY, Lin JW, Cheng BW, Kuo CC, Tsai CT, Chu TS, Huang KH, Wang SM, Lin YH, Chiang CK, Chang HW, Lin CY, Lin LY, Chiu JS, Hu FC, Chueh SC, Ho YL, Liu KL, Lin SL, Yen RF, Wu KD. Kidney impairment in primary aldosteronism. Clin Chim Acta 2011; 412: 1319-1325
    Suche in Google Scholar
  • 65 Matrozova J, Steichen O, Amar L, Zacharieva S, Jeunemaitre X, Plouin PF. Fasting plasma glucose and serum lipids in patients with primary aldosteronism: a controlled cross-sectional study. Hypertension 2009; 53: 605-610
    Suche in Google Scholar
  • 66 Somloova Z, Widimsky Jr J, Rosa J, Wichterle D, Strauch B, Petrak O, Zelinka T, Vlkova J, Masek M, Dvorakova J, Holaj R. The prevalence of metabolic syndrome and its components in two main types of primary aldosteronism. J Hum Hypertens 2010; 24: 625-630
    CrossrefPubMedSuche in Google Scholar
  • 67 Sukor N, Gordon RD, Ku YK, Jones M, Stowasser M. Role of unilateral adrenalectomy in bilateral primary aldosteronism: a 22-year single center experience. J Clin Endocrinol Metab 2009; 94: 2437-2445
    Suche in Google Scholar
  • 68 Ahmed AH, Gordon RD, Sukor N, Pimenta E, Stowasser M. Quality of Life in Patients with Bilateral Primary Aldosteronism before and during Treatment with Spironolactone and/or Amiloride, Including a Comparison with Our Previously Published Results in Those with Unilateral Disease Treated Surgically. J Clin Endocrinol Metab 2011; 96: 2904-2911
    Suche in Google Scholar
  • 69 Sywak M, Pasieka JL. Long-term follow-up and cost benefit of adrenalectomy in patients with primary hyperaldosteronism. Br J Surg 2002; 89: 1587-1593
    CrossrefPubMedSuche in Google Scholar