**4. Treatment**

At our institution, we support the recommendation from the Endocrine Society guidelines1 that a lateralized aldosterone secretion should be demonstrated before undertaking surgery in patients who are candidates for general anesthesia and wish to achieve long-term cure. The goal of treatment for PAL is focused on the normalization of circulating aldosterone or aldosterone receptor blockade to prevent the morbidity and mortality associated with HTN,

Diagnosis and Treatment of Primary Aldosteronism 131

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

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

Until recently, aldosterone excess was thought to play a minor role in the development of hypertension. Beginning in the early 1990s, however, reports from investigators worldwide have found that primary aldosteronism is common in patients with hypertension, with prevalence rates of 10 to 15%. In patients with severe or resistant hypertension, the prevalence of primary aldosteronism is even higher, with a prevalence of approximately 20%. Approximately 30% to 60% of APA patients are improved or have resolution of HTN and hypokalemia with normal SA and PRA after unilateral adrenectomy. HTN is normally resolved within 1 to 6 months and patients with persistent HTN are more likely to be older, require more than two antihypertensive drugs preoperatively, or have a longer duration of HTN or underlying renal dysfunction. The postoperative BP in those with persistent HTN is usually easier to control with fewer medications. The cardiovascular complications of patients who achieve optimal BP control with or without medications eventually decrease to the levels of those with essential HTN. Partial reversal of renal dysfunction, regression of LVM and improved diastolic left ventricular function have been demonstrated after successful treatment of PAL. It has been reported that adrenalectomy for APA is more cost-

[1] Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M, . Case

[2] Stowasser M, Gordon RD, Rutherford JC, Nikwan NZ, Daunt N, Slater GJ. Diagnosis

[3] Conn, J. W. in *Hypertension: Pathophysiology and Treatment* 768–780 (McGraw-Hill, New

[4] Conn, J. W. A concluding response. *Arch. Intern. Med.* 1969; 123: 154–155 .

detection, diagnosis, and treatment of patients with primary aldosteronism: An endocrine society clinical practice guideline. *J Clin Endocrinol Metab* 2008;93(9):3266-

and management of primary aldosteronism. *J Renin Angiotensin Aldosterone Syst.* 

nodular or develop adenoma after surgery.

effective than long-term medical therapy.

bilateral PA. 43

**5. Conclusion** 

**6. References** 

3281.

2001;2(3):156-169.

York, 1977).

hypokalemia and end-organ damage.29 Management strategies should take patient characteristics and desires into consideration. Surgical treatment may not be appropriate for all patients with unilateral hypersecreting adrenal mass but may be reasonable for those with bilateral hypersecretion.
