Incidental and Intentional Medicine Achieve Similar Results in Primary Hyperaldosteronism

Primary hyperaldosteronism is a common cause of hypertension, with significant cardiovascular, renal, and metabolic sequelae. Delayed diagnosis of primary hyperaldosteronism can lead to severe disease and lower cure rates after adrenalectomy. This study investigated the presentation and outcomes of patients who had primary hyperaldosteronism diagnosed after incidental discovery of an adrenal mass.

A retrospective cohort study investigated patients receiving adrenalectomy for primary hyperaldosteronism at the authors' institution from 2001 to 2014. Patients were classified as nonincidental if the aldosteronoma was identified on imaging performed for a hypertension or hypokalemia workup or after a biochemical diagnosis or as incidental if the aldosteronoma was identified on imaging performed for any other reason. Nonincidental and incidental patients were compared in terms of patient demographics, clinical history, preoperative test results, surgical pathology findings, and postoperative course.

The study included 210 patients, 17 (8.1 %) of whom were incidental. At the time of surgical evaluation, 88 % of the incidental patients met the criteria for primary hyperaldosteronism screening based on hypokalemia or the degree of hypertension. The incidental patients were younger than the nonincidental patients, but the two groups were otherwise demographically and clinically similar. The incidental patients had larger aldosteronomas than the nonincidental patients. The nonincidental and incidental patients had similar rates of postoperative cure and failure.

Nonincidental and incidental patients have comparable disease severity before surgical evaluation and similar rates of postoperative cure. Increased adherence to guidelines for screening of primary hyperaldosteronism will lead to a more timely diagnosis for all patients and a higher potential for surgical cure.