Biochemical and clinical remission after adrenalectomy in patients with primary aldosteronism: a retrospective two-center study.

BACKGROUND

Primary hyperaldosteronism (PHA) is a common condition with a prevalence of around 11% in the hypertensive population. For unilateral PHA, the preferred treatment approach is adrenalectomy with the objective to normalize aldosterone levels and its associated harmful effects. However, the reported biochemical outcomes after adrenalectomy vary widely within the literature. This study aimed to evaluate the biochemical and clinical remission rates after unilateral adrenalectomy in patients with PHA.

METHODS

We conducted a retrospective study in two academic centers in Switzerland to evaluate the biochemical and clinical remission rate in patients who underwent unilateral adrenalectomy for confirmed PHA. Biochemical remission was defined as the normalization of aldosterone levels after surgery. Clinical remission was achieved when the patient was able to stop potassium substitution and/or reduce the antihypertensive therapy postoperatively.

RESULTS

Eighty-two patients (51 male, mean age 49.6 years) who underwent unilateral adrenalectomy for PHA from January 2006 to December 2017 were included. Arterial venous sampling (AVS) before surgery was performed to confirm unilateral disease in 88% of patients. AVS results were concordant with the adrenal lesion seen on imaging in all cases. Histology showed an adenoma in 75.6%, and unilateral hyperplasia in 20.7% of cases. Adrenalectomy significantly reduced aldosterone levels (P<0.001) and 91.2% of patients were able to stop potassium substitution. Antihypertensive therapy was discontinued in 53.6% of patients, while the remaining had a significant reduction in mean number of antihypertensive drugs (2.92 vs. 0.92; P<0.001). Only 4.9% of patients continued on 4 antihypertensive drugs.

CONCLUSIONS

In our cohort, unilateral adrenalectomy resulted in biochemical response in 95.1% of patients and complete clinical success with discontinuation of antihypertensive therapy in 53.6%, supporting surgery as an effective treatment for unilateral primary aldosteronism.