[Results of unilateral adrenalectomy for primary hyperaldosteronism]

From 1970 to 1992, 57 patients underwent unilateral adrenalectomy for primary hyperaldosteronism. All were hypertensive and the biochemical profile was diagnosed in all cases but two. 44 out of 57 were operated on using to the posterior Young Mayor approach. The present series included 44 macroadenomas > or = 1 cm in diameter (21 > 2 cm; 23 < or = 2 cm), 7 microadenomas (< 1 cm), 3 associations of macro and microadenomas and 3 cases of unilateral hyperplasia. All were biochemically cured. 4/57 patients remained hypertensive postoperatively (3/44 macroadenomas and 1/3 unilateral hyperplasia). There were two late recurrences, which were both clinical and biochemical (2 macroadenomas < or = 2 cm), and one of these was reoperated on for contralateral multiple "adenomas". Pathological background was defined by preoperative imaging studies with a sensitivity of 100% for MRI (23 cases), 96% for CT-scan (52 cases), 73% for NP 59 scanning (15 cases), 38% for sonography (16 cases) and 85% for venous sampling (7 cases). Cure of hyperaldosteronism or hypertension after unilateral adrenalectomy was therefore not predictable by the pathological background. If a firm diagnosis of primary hyperaldosteronism has been made and the unilaterality of the disease has been established, the patient should be operated. Even adrenalectomy for unilateral hyperplasia can lead to cure, and the syndrome can recur after removal of a solitary macroadenoma.