Prolonged zona glomerulosa insufficiency causing hyperkalemia in primary aldosteronism after adrenalectomy.
BACKGROUND
Unilateral adrenalectomy is the therapy of choice in aldosterone-producing adenoma (APA). Zona glomerulosa (ZG) insufficiency causing hyperkalemia after adrenalectomy has been described in case reports.


OBJECTIVE
Our aim was to analyze the clinical relevance of ZG insufficiency causing hyperkalemia after adrenalectomy in a large series of patients with APA.


METHODS
This was a retrospective chart review.


METHODS
The study was conducted at two tertiary university referral centers in Germany.


METHODS
Data from 110 patients with confirmed APA adrenalectomized at the centers in Munich and Berlin between 2004 and 2012 were analyzed.


METHODS
The primary outcome was the incidence of ZG insufficiency causing hyperkalemia after adrenalectomy; the secondary outcome was the identification of risk factors predisposing for hyperkalemia.


RESULTS
Eighteen of 110 patients (16%) developed postoperative hyperkalemia. The majority of these patients (n = 14) had undetectable plasma aldosterone levels after adrenalectomy; four had low aldosterone levels. In 12 of these patients, hyperkalemia was documented only once and resumed spontaneously. Prolonged hypoaldosteronism accompanied by hyperkalemia was observed in six patients (5% of total cohort). These patients needed continuous mineralocorticoid replacement therapy for 11-46 months. Mineralocorticoid antagonist treatment for 4 wk prior to surgery did not prevent hyperkalemia. In multivariate analysis, preoperatively decreased glomerular filtration rate and increased serum creatinine as well as increased postoperative creatinine and microalbuminuria remained significant predictors of hyperkalemia.


CONCLUSIONS
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.
Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ziemssenstr. 1, 80336 München, Germany.
Evelyn
E
Fischer
Gregor
G
Hanslik
Anna
A
Pallauf
Christoph
C
Degenhart
Ulrich
U
Linsenmaier
Felix
F
Beuschlein
Martin
M
Bidlingmaier
Thomas
T
Mussack
Roland
R
Ladurner
Klaus
K
Hallfeldt
Marcus
M
Quinkler
Martin
M
Reincke
D000236:Adenoma / Q000150:complications / Q000601:surgery*; D000306:Adrenal Cortex Neoplasms / Q000150:complications / Q000601:surgery*; D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications* / Q000601:surgery; D006947:Hyperkalemia / Q000209:etiology*; D007668:Kidney / Q000502:physiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015384:Zona Glomerulosa / Q000601:surgery*