Abstract
The importance of an early diagnosis and appropriate management of patients with primary
aldosteronism (PA) has become increasingly clear because of the adverse impact of
the disorder on cardiovascular and cerebrovascular events and target organ damage.
Adrenalectomy potentially cures patients with unilateral PA resulting in normalisation
of blood pressure or significant clinical improvements in the majority of patients.
Different criteria have been used to evaluate outcomes of unilateral adrenalectomy.
Clinical remission (cure of hypertension) is observed in 6% to 86% of patients and
clinical benefits from surgery are seen in the majority. Several factors have been
identified that predict clinical success after surgery such as age, sex, anti-hypertensive
medication dosage and known duration of hypertension. Biochemical remission of PA
after unilateral adrenalectomy, characterised by the resolution of hyperaldosteronism
and correction of pre-surgical hypokalaemia, is observed in 67% to 100% of patients
with unilateral PA. In only a small proportion of patients, adrenalectomy fails to
resolve hyperaldosteronism and inappropriate aldosterone production persists after
surgery. In this review we discuss the potential reasons for failing to cure hyperaldosteronism
after unilateral adrenalectomy for unilateral primary aldosteronism.
Key words
Primary aldosteronism - adrenalectomy - aldosterone-producing adenoma - bilateral
adrenal hyperplasia - persistent hyperaldosteronism
