ADRENALECTOMY FOR PRIMARY ALDOSTERONISM - LONG-TERM FOLLOW-UP-STUDY IN 29 PATIENTS

Primary aldosteronism consists of a mixture of subgroups. The operativ e treatment is successful only in cases of aldosterone-producing neopl asia (and in rare cases of primary unilateral hyperplasia); all other cases should be treated medically. The aim of this study was to determ ine if aldosterone-producing neoplasia had been successfully different iated from the other subgroups and the outcome of operative treatment. Altogether 29 patients with primary aldosteronism were operated on be tween January 1, 1979 and December 31, 1993. Patient charts were revie wed retrospectively. The follow-up data were collected from the patien ts' charts, and all patients were contacted to obtain recent blood pre ssure and serum potassium values. The patients were asked about sympto ms related to hyperaldosteronism. If any suspicion of recidive aldoste ronism was present, patients were carefully reexamined by hormonal tes ts and computed tomography (CT). A total of 27 patients had unilateral adenoma, 1 patient had hyperplasia. and 1 patient had an aldosterone- producing cortical carcinoma. There was no operative mortality or morb idity. The serum potassium level had normalized in all patients. Mean follow-up time was 76 months. One patient died during the follow-up fr om cholangiocarcinoma; 11 patients (41%) were cured by the operation, 10 patients (37%) have a mild but medicated hypertension, and in the r emaining 22% the hypertension persisted but was well controlled by the medication. Of the 29 patients, 28 were correctly diagnosed as having an aldosterone-producing neoplasm, Basic hormonal studies and CT can be used effectively to differentiate aldosterone-producing neoplasia f rom hyperplasia in most cases.