Clinical outcomes following unilateral adrenalectomy in patients with primary aldosteronism.
BACKGROUND
In approximately half of cases of primary aldosteronism (PA), the cause is a surgically-resectable unilateral aldosterone-producing adrenal adenoma. However, long-term data on surgical outcomes are sparse.


OBJECTIVE
We report on clinical outcomes post-adrenalectomy in a cohort of patients with PA who underwent surgery.


METHODS
Retrospective review of patients treated for PA in a single UK tertiary centre.


METHODS
Of 120 consecutive patients investigated for PA, 52 (30 male, median age 54, range 30-74) underwent unilateral complete adrenalectomy. Blood pressure, number of antihypertensive medications, and serum potassium were recorded before adrenalectomy, and after a median follow-up period of 50 months (range 7-115). Recumbent renin and aldosterone were measured, in the absence of interfering antihypertensive medication, ≥3months after surgery, to determine if PA had been biochemically cured.


RESULTS
Overall, blood pressure improved from a median (range) 160/95 mmHg (120/80-250/150) pre-operatively to 130/80 mmHg (110/70-160/93), P < 0.0001. 24/52 patients (46.2%) had cured hypertension, with a normal blood pressure post-operatively on no medication. 26/52 (50%) had improved hypertension. 2/52 patients (3.8%) showed no improvement in blood pressure post-operatively. Median (range) serum potassium level increased from 3.2 (2.3-4.7) mmol/l pre-operatively to 4.4 mmol/l (3.3-5.3) post-operatively, P < 0.0001). Median (range) number of antihypertensive medications used fell from 3 (0-6) pre- to 1 post-operatively (range 0-4), P < 0.0001.


CONCLUSIONS
Unilateral adrenalectomy provides excellent long-term improvements in blood pressure control, polypharmacy and hypokalaemia in patients with lateralizing PA. These data may help inform discussions with patients contemplating surgery.
From the Departments of Endocrinology, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
M J
MJ
Hannon
From the Departments of Endocrinology, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
W C
WC
Sze
Department of Surgery, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
R
R
Carpenter
Department of Surgery, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
L
L
Parvanta
Department of Radiology, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
M
M
Matson
Department of Radiology, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
A
A
Sahdev
From the Departments of Endocrinology, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
M R
MR
Druce
Department of Pathology, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
D M
DM
Berney
From the Departments of Endocrinology, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
M
M
Waterhouse
From the Departments of Endocrinology, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
S A
SA
Akker
From the Departments of Endocrinology, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
W M
WM
Drake
D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000450:Aldosterone / Q000097:blood; D000959:Antihypertensive Agents / Q000008:administration & dosage; D001794:Blood Pressure / Q000502:physiology; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006973:Hypertension / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D019338:Polypharmacy; D011188:Potassium / Q000097:blood; D012083:Renin / Q000097:blood; D012189:Retrospective Studies; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D000450:Aldosterone; D012083:Renin; D011188:Potassium