Endocrine Abstracts

Primary aldosteronism (PA) is an important cause of hypertension which confers significant cardiometabolic risk. In approximately half of cases, the cause is a surgically resectable unilateral aldosterone-producing adrenal adenoma, making PA the most common potentially curable form of hypertension. Despite this, long-term data on surgical outcomes that could be used to guide discussions with patients are sparse. Here, we report on clinical outcomes several years post-adrenalectomy in those patients from our prospectively studied cohort who underwent surgery.

Of 120 consecutive patients investigated for PA, 51 underwent laparoscopic-assisted adrenalectomy. Blood pressure, number of antihypertensive medications, and serum potassium were recorded before adrenalectomy, and at the time of most recent follow-up. Recumbent renin and aldosterone were measured ≥3 months after surgery, to determine if PA had been biochemically cured. This was performed in the absence of interfering antihypertensive medication, and with oral potassium supplementation given as necessary.

The cohort consisted of 31 males and 20 females, median age 54 (range 30–83). Median duration of follow up was 48 months (range 3–154). Median pre-operative blood pressure (on medication) was 160/95 (range 120/80–250/150). Overall, blood pressure significantly improved post-operatively, to a median of 130/80 (range 110/70–160/93, P<0.0001). Median serum potassium level increased from 3.2 mmol/l pre-operatively (range 2.3–4.7) to 4.4 mmol/l post-operatively (range 3.3–5.3, P<0.0001). Median number of antihypertensive medications used improved from median 3 pre-operatively to median 1 post-operatively (P<0.0001). 3/51 patients (5.9%) did not achieve any improvement in blood pressure post-operatively; however, histological examination of these patients’ removed adrenal glands confirmed the presence of fully excised, typical Conn’s adenomas in each case.

Laparoscopic-assisted unilateral adrenalectomy provides excellent long term improvements in blood pressure control, polypharmacy, and hypokalaemia. These data may help inform discussions with patients about possible surgical outcomes.