What is the role of surgery in the treatment of hyperaldosteronism?

Updated: Oct 19, 2018
  • Author: George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London); Chief Editor: Robert P Hoffman, MD  more...
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Answer

Surgical excision of the affected adrenal gland is recommended for all patients with hyperaldosteronism who have a proven APA. Compared with an open approach, laparoscopic adrenalectomy significantly reduces operative morbidity, substantially shortens the hospital stay, and reduces blood loss. The risk of operative complications is related directly to the experience of the surgeon. Some surgeons prefer a posterior retroperitoneoscopic approach, especially for patients with smaller tumors (< 6 cm), prior abdominal surgery and lower BMI. Furthermore, recent data suggest that robotic procedures are associated with shorter hospital stay and less morbidity than laparoscopic adrenalectomy. [3]

Ensuring good control of BP and replenishment of potassium levels preoperatively is important. The literature on adults indicates that 30-60% of patients are cured when cure of hypertension is defined as BP lower than 140/90 mm Hg without antihypertensive medications. Most patients (40-70%) experience an improvement in BP control. These rates are likely to be even better in children who have fewer independent factors that predispose to hypertension. BP typically normalizes or shows maximal improvement 1-6 months postoperatively, although it can continue to decrease for as long as 1 year after surgery. Hypokalemia resolves and aldosterone levels normalize in more than 98% of patients who undergo adrenalectomy for an APA.


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