Surgical treatment of primary aldosteronism

An aldosterone-producing adenoma is the cause of primary aldosteronism in about 85%. Unilateral adrenalectomy cures the potassium wasting and normalizes the blood-pressure in more than 70%, independently of the severity or duration of the hypertension. The location of an aldosteronoma is best obtained by computerized tomography and selective venous catheterization with determination of the aldosterone/cortisol ratio. When the biochemical studies suggest hyperplasia, medical treatment is recommended. It is, however, our policy to remove an adrenal gland with hyperplasia, when catheterization demonstrates unilateral hyperfunction. At operation a posterior or a flank approach is preferably used.