REVERSIBLE SUPPRESSION OF THE RENIN-ALDOSTERONE AXIS AFTER UNILATERALADRENALECTOMY FOR ADRENAL ADENOMA

Reduced adrenocortical (aldosterone and cortisol) and adrenomedullary (adrenaline) secretory mass after unilateral adrenalectomy for aldoste rone-producing adenoma has been associated with long-term hypotension (more than 2 years) in some studies, In these patients, cortisol and a ldosterone levels are low, whereas plasma renin activity is high. Othe r studies suggest that normotension and normal plasma renin activity a nd serum aldosterone and cortisol levels are achieved in 60% to 87% of the patients without evidence of decreased adrenal mass, whereas the remaining patients may continue to have hypertension. We report a uniq ue case in which unilateral adrenalectomy for adrenal adenoma was foll owed by severe hyperkalemia, marked volume depletion and undetectable plasma renin activity, and serum aldosterone, suggesting marked, chron ic suppression of the renin-aldosterone axis, One year later, a gradua l return to normokalemia, normotension, and normal plasma renin activi ty and aldosterone levels was achieved, indicating resolution of the s uppression of the renin-aldosterone axis. Patients undergoing unilater al adrenalectomy for aldosteronoma should be followed up closely after unilateral adrenalectomy of adrenal adenoma to avoid life-threatening hyperkalemia and severe intravascular volume depletion. (C) 1998 by t he National Kidney Foundation, Inc.