**4.2 Surgical treatment**

Laparoscopic adrenalectomy is currently the best treatment, and can be performed during a short hospital stay at a very low operative risk.38-39 This surgery has cured primary aldosteronism in 33–72% of patients and resulted in marked improvements in 40–50% of patients.40,41 Approximately one-third of all PAL patients has clear lateralization of aldosterone production and will benefit from unilateral adrenalectomy. Laparoscopic adrenectomy is the most suitable therapy for APA or unilateral adrenal hyperplasia. After adrenalectomy hypertension is cured in around 50% of patients with APA (range 33–70%) [3] with the remaining patients showing a significant reductions in blood pressure and number of antihypertensive drugs. Chronic suppression of the renin-angiotensin axis may cause transient postoperative hypoaldosteronism and a liberal sodium diet should be allowed to prevent hyperkalemia after the surgery. An I.V. infusion of 0.9% sodium chloride every 8 to 12 hours may be necessary to avoid postoperative intravascular volume depletion. All antihypertensive medications, especially spironolactone and amiloride, should be withheld and other BP medications may be cautiously reinstituted as needed within a few days. The data on follow-up assessment of the remaining adrenal gland after surgery is scanty. Postoperative SA, PRA, and ARR are commonly repeated.17 These authors also periodically obtained CT scan in their patients at 1 to 3 yearly intervals because they have observed that the remaining adrenal gland could slowly increase in size, become nodular or develop adenoma after surgery.

Of note, adrenalectomy in APA patients has also been reported to improve self-assessed quality of life. 42 A recent study suggests that, for reasons which are incompletely understood, unilateral adrenalectomy may be beneficial in carefully selected patients with bilateral PA. 43
