Adrenalectomy in Primary Aldosteronism: A Long-Term Follow-Up Study

Abstract

The effect of unilateral adrenalectomy in primary aldosteronism was analyzed in 38 patients with unilateral adenoma, 12 cases with idiopathic bilateral hyperplasia and 1 patient suffering from an aldosterone-producing carcinoma. Responses to surgery differed markedly. In all 38 adenoma cases plasma aldosterone dropped to normal levels and remained within normal range during a mean follow-up period of 75 ± 12 months. 23 (61 %) of these patients became normotensive without medication and thus could be classified as definitely cured. 34% (13 patients) improved (normotensive under medical treatment) and only 2 cases (5 %) remained hypertensive despite sufficient medical treatment. In the hyperplasia group, however, the effect of adrenalectomy was disappointing. None of these subjects showed a long-lasting normalization of aldosterone secretion. A temporary remission for no more than 3–4 months was achieved in only 3 patients. In a fourth case with macronodular hyperplasia, primary aldosteronism relapsed after a 6-year period of normal blood pressure and aldosterone values. Therefore, 6 years after adrenalectomy no hyperplasia patient was definitely cured in contrast to 61 % of the adenoma cases. The problems in the management of hypertension in adrenal hyperplasia are furthermore documented by a poorer blood pressure control despite antihypertensive medication and a high rate of vascular complications. During the follow-up, 3 of 12 hyperplasia patients experienced a cerebrovascular event and 1 a myocardial infarction.

Discriminating Factors for Recurrent Hypertension in Patients with Primary Aldosteronism after Adrenalectomy

“…Finally, because patients did not undergo biochemical and hormonal examination at follow-up, we can not completely exclude the recurrence of hyperaldosteronism. However, no patient in our study reported symptoms or signs suggestive of such recurrence, and in general the recurrence of this syndrome is very rare (3,10,11,14,15).…”

Proportion of Patients With Hypertension Resolution Following Adrenalectomy for Primary Aldosteronism: A Systematic Review and Meta‐Analysis

“…From the studies that qualified for this meta‐analysis, two suggested a 0% hypertension resolution rate when unilateral adrenal hyperplasia was the final pathology. This result is highly preliminary as it was derived from only six patients, and therefore has low power, but it may suggest that the magnitude of benefit may be smaller for patients with unilateral IHA pathology . Other papers not included in the meta‐analysis do appear to show clinical benefit to surgical intervention even with diffuse hyperplasia as the pathology .…”

Aldosterone-Producing Adrenocortical Adenoma Complicated by Chronic Renal Failure

“…It is well known that adrenalectomy is the best treatment for adrenocortical adenoma [7,8]. However, our patient had chronic renal failure as a risk factor for surgical treat- ment [15].…”

“…Although it has been confirmed that unilateral adrenalectomy is effective in treating aldosterone-producing adrenocortical adenoma [7,8], postoperative hypertension persists in 12-60% of these patients [3][4][5][6][7][8].…”