Surgery for primary hyperaldosteronism

The most common underlying disorder in primary aldosteronism is a benign unilateral adenoma. Some cases, termed idiopathic, are secondary to bilateral adrenal hyperplasia, and a few are caused by adrenocortical carcinoma. The therapeutic alternatives are pharmacologic management with an aldosterone antagonist and surgical adrenalectomy. The author reviews patient selection and preparation for surgery, the technical details of adrenalectomy in this setting, and relevant postoperative considerations.