Dec. 03, 2024
Primary aldosteronism, a condition marked by excessive aldosterone production from the adrenal glands, induces resistant hypertension and may cause difficult to manage hypokalemia. Adrenal vein sampling is the gold standard modality for distinguishing unilateral from bilateral adrenal disease. Traditionally, unilateral adrenalectomy has been offered only to patients with unilateral disease as confirmed by adrenal venous sampling, while treatment options for patients with bilateral idiopathic aldosteronism (IHA) have been limited, generally involving lifelong medication rather than surgical intervention.
In a study published in the World Journal of Surgery, physicians from Mayo Clinic reveal promising outcomes for unilateral adrenalectomy in selected patients with IHA.
Travis J. McKenzie, M.D., with Endocrine Surgery at Mayo Clinic in Rochester, Minnesota, reports: "Treating carefully selected patients with unilateral adrenalectomy for IHA can still result in significant benefit for selected patients. Over a 10-year study period, 24 (10.6%) of 226 patients with IHA underwent unilateral adrenalectomy after a detailed discussion of risks, benefits and alternatives. These patients were more likely to be men (58%), with median highest preoperative systolic blood pressure of 153 mm Hg and median number of preoperative antihypertensives taken per patient of three. Preoperative hypokalemia was present in 92% of the cohort. The median duration of follow-up was 16 months."
About 76% of those with preoperative hypokalemia had normalization of serum potassium levels at last follow-up. Additionally, at the time of last follow-up, 65% had improvement in hypertension with 11% being off all antihypertensive medications. The postoperative median number of antihypertensives taken was 1.
Dr. McKenzie continues, "While not completely curing primary aldosteronism, decreasing the quantity of hormone produced by removing one adrenal gland can result in significant clinical benefit."
Trenton R. Foster, M.D., with Endocrine Surgery at Mayo Clinic in Minnesota and co-author of the study acknowledges the impact these results have on the future of surgical treatment for primary aldosteronism. "Expanding the indications for unilateral adrenalectomy to include selected patients with bilateral aldosterone excess allows for many more patients to benefit from surgical treatment than previously realized," says Dr. Foster.
Dr. McKenzie goes on to say: "Minimally invasive adrenalectomy in the hands of experienced surgeons is extremely safe and can frequently be performed as an outpatient procedure. The outcomes from this study demonstrate the potential for unilateral adrenalectomy to provide an excellent option in helping manage this complex condition."
The study adds a valuable dimension to current treatment paradigms, suggesting that unilateral adrenalectomy could be considered as a viable adjunct to medical therapy for select patients with bilateral aldosterone excess. For the broader medical community, this study is a hopeful step toward a more individualized, effective management of primary aldosteronism.
For more information
Yamashita TS, et al. Unilateral adrenalectomy for primary aldosteronism due to bilateral adrenal disease can result in resolution of hypokalemia and amelioration of hypertension. World Journal of Surgery. 2023;47:314.
Refer a patient to Mayo Clinic.