Reduced adrenal secretory mass after unilateral adrenalectomy for aldosterone-producing adenoma may explain unexpected incidence of hypotension.
In a prospective study of 37 patients who had unilateral adrenalectomy for an aldosterone-producing adenoma, five of 33 (15%) were symptomatically hypotensive after at least 1 year, and eight of 29 (28%) who were observed 3, 6, 12, 18 and 24 months after the operation showed 2-year blood pressures below the fifth percentile for age- and sex-matched controls. Postoperatively, plasma aldosterone was lower, and plasma renin activity higher than in controls, these differences being more marked in the hypotensive group. Pre-operatively elevated atrial natriuretic factor fell to levels lower than in controls. These serial changes in volume-regulatory hormones are consistent with chronic hypovolaemia, due to relative hypoaldosteronism. Plasma cortisol was lower 6 months after the operation and plasma adrenaline levels fell by half. A reduced adrenocortical (aldosterone and cortisol) and adrenomedullary (adrenaline) secretory mass may play a role in the hypotension observed after unilateral adrenalectomy.
Gordon
R D
RD
University of Queensland Department of Medicine, Greenslopes Hospital, Brisbane, Australia.
Hawkins
P G
PG
Hamlet
S M
SM
Tunny
T J
TJ
Klemm
S A
SA
Bachmann
A W
AW
Finn
W L
WL
D000236:Adenoma / Q000150:complications / Q000378:metabolism* / Q000601:surgery; D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000378:metabolism* / Q000601:surgery; D000311:Adrenal Glands / Q000378:metabolism*; D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood / Q000378:metabolism*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D012083:Renin / Q000097:blood; D013997:Time Factors
D000450:Aldosterone; D012083:Renin