Outcome of surgery for primary hyperaldosteronism

Primary hyperaldosteronism (PHA) frequently causes secondary hypertension and is a surgically amenable disease if associated with unilateral adenoma. Patients who underwent laparoscopic adrenalectomy at the authors' department were followed to identify clinical parameters that predict resolution of hypertension.

All patients with PHA and adrenalectomy from 1993 to 2009 were identified. Charts and follow-up data were reviewed for clinical parameters and hormone levels. Univariate and multivariate analysis were performed with SPSS 15.0.

A cohort of 30 female and 24 male patients underwent laparoscopic adrenalectomy. Hypokalemia was observed in 47/54 (87%) patients. Twenty patients (37%) were cured without any further need of antihypertensive medication, 20 (37%) patients experienced an improvement in hypertension, and 14 (26%) patients remain unaffected. Consequently, hypertension was resolved or improved in 40/54 (74%) patients. A shorter duration of hypertension (<6 years), the number of antihypertensive drugs (<3), and the serum creatinine level (<1.3 mmol/l) were independent predictors of resolution of hypertension in a multivariate analysis. At final follow-up after a mean of 49 ± 40 months, resolution of hypertension was observed in 17/30 (57%) patients. Interestingly, in 10/17 patients a period longer than 12 months was required before a resolution of hypertension was observed. Coexistent hyperplasia, which was observed in 30% of patients, did not correlate with outcome.

In 50% of patients with PHA, hypertension resolves after laparoscopic adrenalectomy, but the process may require more than 12 months. Patients with a duration of hypertension of more than 6 years, more than 3 antihypertensive drugs, and elevated serum creatinine have a higher risk of persistent hypertension after surgery. Coexistent hyperplasia in the resected adrenal gland is not associated with persistent hypertension.