Adrenalectomy in primary aldosteronism: a long-term follow-up study

• Published in: Cardiology Vol. 72 Suppl 1; p. 107
• Main Authors: Groth, H, Vetter, W, Stimpel, M, Greminger, P, Tenschert, W, Klaiber, E, Vetter, H
• Format: Journal Article
• Language: English
• Published: Switzerland 1985
• Subjects: Adenoma - surgery; Adolescent; Adrenal Gland Neoplasms - surgery; Adrenal Glands - pathology; Adrenalectomy; Adult; Aldosterone - blood; Blood Pressure; Female; Follow-Up Studies; Humans; Hyperaldosteronism - surgery; Hyperplasia; Hypertension - surgery; Male; Middle Aged; Postoperative Complications - etiology; Potassium - blood; Renin - blood; Sodium - blood
• ISSN: 0008-6312
• DOI: 10.1159/000173955

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.