Long-term follow-up of surgically treated patients with primary aldosteronism

Abstract

The aim of this study was the assessment of long-term effects of adrenalectomy on blood pressure and antihypertensive medication in patients with primary aldosteronism (PA). 24 patients (15 women and 9 men, mean age: 48.3±10.8 years) were adrenalectomized for PA between 1989 and 2001. All subjects were reexamined with a complete clinical work-up after a mean follow-up of 86±48 months including blood pressure readings (135/85mmHg defined as normal), endocrine adrenal function and specific medication. All patients suffered of hypertension (onset 8.5±5.5 years prior to operation), in 92% of the patients hypokalemia was present (onset 2.0±2.6 years prior to operation). Histopathologic examination showed unilateral adenoma in 23 patients and a bilateral hyperplasia in one patient. 25% of the patients were cured (no future antihypertensive treatment) with 5 of these 6 patients under 50 years of age. In the remaining 18 patients the total number of antihypertensive drugs decreased from 2.3 preoperatively to 1.2 at follow-up. Plasma aldosterone to plasma-renin-activity ratio (ARQ) measured in 20 patients was below 300 pg/ml per ng/ml/h in all but one patient. Also the potassium concentration was in the normal range in all but one patient. This patient revealed a contralateral aldosterone-secreting adrenal adenoma in the further endocrine and imaging work-up 44 months after the first operation with a ratio of 1754 pg/ml per ng/ml/h and a potassium of 3.2 mmol/l. Despite normalized aldosterone, renin and potassium levels a long-lasting hypertension in patients over 50 years may explain persistent blood pressure elevation. The patient with the recurrent disease on the contralateral side may represent bilateral adrenal hyperplasia with sequential tumor formation on the other side. This case demonstrates the importance of extensive preoperative biochemical testing for the management of patients with adrenal mass and hyperaldosteronism.