title: Reduced adrenal secretory mass after unilateral adrenalectomy for aldosterone-producing adenoma may explain unexpected incidence of hypotension.
abstract: 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.
authors.affiliation: University of Queensland Department of Medicine, Greenslopes Hospital, Brisbane, Australia.
authors.forename: R D
authors.initials: RD
authors.lastname: Gordon
authors.forename: P G
authors.initials: PG
authors.lastname: Hawkins
authors.forename: S M
authors.initials: SM
authors.lastname: Hamlet
authors.forename: T J
authors.initials: TJ
authors.lastname: Tunny
authors.forename: S A
authors.initials: SA
authors.lastname: Klemm
authors.forename: A W
authors.initials: AW
authors.lastname: Bachmann
authors.forename: W L
authors.initials: WL
authors.lastname: Finn
mesh_terms: 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
chemical_list: D000450:Aldosterone; D012083:Renin