Prolonged Zona Glomerulosa Insufficiency Causing Hyperkalemia in Primary Aldosteronism after Adrenalectomy

Fischer, Evelyn; Hanslik, Gregor; Pallauf, Anna; Degenhart, Christoph; Linsenmaier, Ulrich; Beuschlein, Felix; Bidlingmaier, Martin; Mussack, Thomas; Ladurner, Roland; Hallfeldt, Klaus; Quinkler, Marcus; Reincke, Martín

doi:10.1210/jc.2012-2234

Cited by 70 publications

(100 citation statements)

References 40 publications

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“…Postoperative hyperkalemia due to functional mineralocorticoid insufficiency in the contralateral adrenal was nevertheless reported in 15-30% of cases despite preventive prescription of preoperative spironolactone [19,20]. It was generally moderate and transient.…”

Section: Specific Complications and Short-term Follow-upmentioning

confidence: 99%

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SFE/SFHTA/AFCE consensus on primary aldosteronism, part 6: Adrenal surgery

Steichen

Amar

Chaffanjon

et al. 2016

Annales d'Endocrinologie

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Section: Specific Complications and Short-term Follow-upmentioning

confidence: 99%

“…Spironolactone and potassium supplementation should be interrupted at surgery to reduce this risk, and kalemia should be checked postoperatively, especially in case of chronic kidney failure [20]. Even so, however, up to 5% of patients may require prolonged postoperative fludrocortisone treatment [19].…”

Section: Specific Complications and Short-term Follow-upmentioning

confidence: 99%

SFE/SFHTA/AFCE consensus on primary aldosteronism, part 6: Adrenal surgery

Steichen

Amar

Chaffanjon

et al. 2016

Annales d'Endocrinologie

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“…Nonetheless, postoperative hyperkalemia is seen in up to 30% of patients. 24,25 It is usually mild and transient, but MRA treatment and potassium supplements should be discontinued at the time of surgery, to minimize the risk, and serum potassium concentrations should be monitored closely, particularly in patients with chronic kidney disease (CKD). 25 In addition to the restriction of potassium-rich food, fludrocortisone has been used in rare cases of persistent hyperkalemia due to postoperative hypoaldosteronism.…”

Section: Unilateral Adrenalectomymentioning

confidence: 99%

“…25 In addition to the restriction of potassium-rich food, fludrocortisone has been used in rare cases of persistent hyperkalemia due to postoperative hypoaldosteronism. 24 Hormonal studies should be carried out for patients with high BP after surgery, to distinguish between persistent PA and associated essential hypertension.…”

Section: Unilateral Adrenalectomymentioning

confidence: 99%

Outcomes of Drug-Based and Surgical Treatments for Primary Aldosteronism

Steichen

Lorthioir

Zinzindohoué

et al. 2015

Advances in Chronic Kidney Disease

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Treatments for primary aldosteronism (PA) aim to correct or prevent the deleterious consequences of hyperaldosteronism: hypertension, hypokalemia and direct target organ damage. Patients with unilateral PA considered fit for surgery can undergo laparoscopic adrenalectomy, which significantly decreases blood pressure and medications in most cases, and cures hypertension in about 40%. Mineralocorticoid receptor antagonists (MRA) are used to treat patients with bilateral PA and those with unilateral PA if surgery is not possible or not desired. Spironolactone is more potent than eplerenone, but high doses are poorly tolerated in men. MRA can be replaced or complemented with epithelial sodium channel blockers, such as amiloride. Thiazide diuretics and calcium channel blockers are used when the first-line drugs are insufficient to control blood pressure. Dietary sodium restriction should be implemented in all cases, because the deleterious consequences of hyperaldosteronism are dependent on salt loading. Several studies comparing the results of surgery and MRA have reported no differences in terms of blood pressure, serum potassium concentration or cardiovascular and renal outcomes, although the benefits of treatment tend to be observed sooner with surgery.PA patients display relative glomerular hyperfiltration, which is reversed by specific treatment, revealing chronic kidney disease in 30% of patients. However, further kidney damage is prevented by the treatment of PA. Clinical summary-The goals of treatment are the normalization of serum potassium concentration, blood pressure control and prevention of the direct effects of excess aldosterone on target organs. 3-The non-surgical treatment of PA is based on mineralocorticoid receptor antagonists and dietary sodium restriction.-Epithelial sodium channel blockers are used when mineralocorticoid receptor antagonists are not well tolerated; thiazide diuretics and calcium channel blockers are used when blood pressure control is insufficient with the first-line treatment.-Laparoscopic adrenalectomy is safe and decreases BP and medication requirements in patients with unilateral PA; drug-based treatments are appropriate in cases in which surgery is inappropriate or not desired.

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“…In the trial reported by Parthasarathy et al (24) serum potassium level was modestly higher on 75-225 mg spironolactone than on 100-300 mg eplerenone (3.94 vs 3.83 mmol/l, P!0.001). Preoperative treatment with MRAs does not seem to increase the incidence of hypoaldosteronism or hyperkalemia after surgery (29). After surgery, MRAs should be withdrawn in the first postoperative day to avoid hyperkalemia (7).…”

Section: Mras In the Perioperative Periodmentioning

confidence: 99%

PROGRESS IN PRIMARY ALDOSTERONISM: Mineralocorticoid antagonist treatment for aldosterone-producing adenoma

Amar

Lorthioir

Azizi

et al. 2015

European Journal of Endocrinology

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Mineralocorticoid receptor antagonists have been used in patients with aldosterone-producing adenomas (APAs) as a test designed to predict the blood pressure (BP) outcome of surgery. They are commonly used in patients undergoing adrenalectomy to reduce BP and increase plasma potassium levels during the preoperative period. A small number of studies have compared the effects of surgery and mineralocorticoid antagonists either on BP, on serum potassium levels, or on the incidence of cardiovascular and renal outcomes in patients with primary aldosteronism with or without an APA; these studies found no difference between the two therapeutic options. Mineralocorticoid receptor antagonists can be used as a maintenance treatment for patients with APAs, who are judged to be poor operative risks or who do not want to undergo surgery.

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Prolonged Zona Glomerulosa Insufficiency Causing Hyperkalemia in Primary Aldosteronism after Adrenalectomy

Abstract: Persistent postoperative hypoaldosteronism with hyperkalemia occurs in 5% of adrenalectomized PA patients through prolonged ZG insufficiency, requiring long-term fludrocortisone treatment. Potassium levels after adrenalectomy must be monitored to avoid life-threatening hyperkalemia.

Cited by 70 publications

References 40 publications

SFE/SFHTA/AFCE consensus on primary aldosteronism, part 6: Adrenal surgery

SFE/SFHTA/AFCE consensus on primary aldosteronism, part 6: Adrenal surgery

Outcomes of Drug-Based and Surgical Treatments for Primary Aldosteronism

PROGRESS IN PRIMARY ALDOSTERONISM: Mineralocorticoid antagonist treatment for aldosterone-producing adenoma

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