Role of unilateral adrenalectomy in bilateral primary aldosteronism: a 22-year single center experience.
OBJECTIVE
The aim of the study was to examine blood pressure and biochemical responses to unilateral adrenalectomy in patients with bilateral primary aldosteronism (PA) and identify predictive parameters.


BACKGROUND
PA considered due to bilateral autonomous production of aldosterone is usually treated medically. Unilateral adrenalectomy has been considered ineffective. Because quality outcome data are lacking and medical treatment may cause adverse effects or fail to control hypertension, defining the role for unilateral adrenalectomy in bilateral PA is an important clinical issue.


METHODS
Between 1984 and 2004, 51 of 684 patients diagnosed with bilateral PA underwent unilateral adrenalectomy. This report is based on the records of the 40 considered suitable for inclusion, who were followed for at least 12 (median, 56.4) months.


RESULTS
Hypertension was cured in 15% of patients and improved in 20%, usually within 1 yr of unilateral adrenalectomy. The proportion with controlled hypertension was significantly (P < 0.001) higher after adrenalectomy (65%) than before (25%). Mean systolic (P < 0.001) and diastolic (P < 0.001) blood pressure, left ventricular mass index (P < 0.05), plasma upright aldosterone (P < 0.05), and aldosterone/renin ratio (P < 0.001) fell. Serum creatinine independently predicted hypertension cure.


CONCLUSIONS
Although this retrospective analysis of patients from a single center does not permit prediction of response rates among patients diagnosed elsewhere, it suggests that unilateral adrenalectomy can be beneficial in some patients with apparent bilateral PA and should not be dismissed as a treatment option.
Sukor
Norlela
N
Endocrine Hypertension Research Center, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Australia.
Gordon
Richard D
RD
Ku
Yee Kim
YK
Jones
Mark
M
Stowasser
Michael
M
D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood; D001794:Blood Pressure / Q000502:physiology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000450:Aldosterone