Abstract
Purpose: Primary Aldosteronism (PA) is the commonest cause of secondary hypertension and can be cured by unilateral adrenalectomy. We report the short and long-term outcomes after adrenalectomy performed at a single UK centre over a period of 24 years.
Methods: Retrospective analysis of biochemical(potassium, aldosterone, renin and ARR) radiological (CT/MRI, AVS, nuclear scans) and clinical (surgical complications, blood pressure, number of antihypertensive medications) short and long terms outcomes in patients who underwent adrenalectomy for PA between 1998 and 2021. Standardised PASO and Clavien-Dindo criteria to assess biochemical, clinical and surgical outcomes were used.
Results: 82 patients treated with adrenalectomy for PA over a 24 year period, short term follow up data (within 3 months from surgery) was available for 82 patients (M45, F37, mean age 51.7 years), 24 of them were followed at least 60 months( range 60 to 72 months) 77 (93.9%) patients had laparoscopic surgery (1 conversion). 7 patients had postoperative complications classified as Clavien-Dindo II(4), IIIa(1) and IVa(2). Median LOS was 2.5 days (1-12).
Complete and partial clinical success was achieved in 29% and 58.3% and 41.7% and 45.8% of patients in short and long term respectively. Clinical benefit was observed in 88% of patients. Complete biochemical success was achieved in 95.8% of patients in short and long term.
Conclusion: Unilateral adrenalectomy in patients with PA achieved clinical benefit in 88% and biochemical cure in almost all of them. Our data suggest that these benefits persisted for at least 5 years.