Urol. praxi, 2013; 14(5): 224-228

Impact of diagnostic methods on clinical outcomes of unilateral adrenalectomy for primary hyperaldosteronism

MUDr.Igor Hartmann¹, MUDr.Michal Grepl, Ph.D.¹, MUDr.Aleš Vidlář, Ph.D.¹, MUDr.Oldřich Šmakal, Ph.D.¹, MUDr.Filip Čtvrtlík, Ph.D.², MUDr.Jan Václavík, Ph.D.³, doc.MUDr.Zdeněk Fryšák, CSc.⁴, doc.MUDr.Vladimír Študent, Ph.D.¹

¹ Urologická klinika Fakultní nemocnice Olomouc

² Radiologická klinika Fakultní nemocnice Olomouc

³ I. interní klinika Fakultní nemocnice Olomouc

⁴ III. interní klinika Fakultní nemocnice Olomouc

on Department of Urology University Hospital Olomouc



Background: Primary hyperaldosteronism is a frequent cause of secondary hypertension. In case of unilateral overproduction of aldosterone

by the adrenal gland, the condition may be successfully treated by surgery. Patients who had underwent adrenalectomy for

hyperaldosteronism in the authors ’center were followed to assess the clinical effect of the treatment.

Methods: All patients undergoing adrenalectomy for hyperaldosteronism in 2000–2011 on Department of Urology University Hospital

Olomouc were identified. Demographic data, results of biochemical tests, radiological and histological investigations, and effects of

surgery on hypertension, hypocalemia and aldosterone: plasma renin activity (ALD: PRA) ratio over a 12-month follow-up were retrospectively

obtained. The data were statistically processed.

Results: A total of 62 patients underwent adrenalectomy for hyperaldosteronism. Of those, 36 (58 %) were females and 26 (42 %) were

males. In 36 (58 %) patients, adrenal venous sampling was performed. The most frequent histological finding was hyperplasia, found in

50 % of cases. Complete results of 1-year postoperative follow-up were obtained from 51 patients. Antihypertensives were discontinued

in 33 % of patients and reduced in 49 % as compared with the initial situation at 12 months. Potassium levels were normalized in 92 %

and ALD: PRA ratio in 84 % of patients. Patients who were indicated for adrenalectomy based on adrenal velus sampling (AVS) had better

blood pressure outcomes. At 12 months postoperatively, blood pressure was positively influenced in as many as 28/32 (88 %) patiens,

vers. 14/19 (74 %) in the group without AVS.

Conclusions: In this group of patients, laparoscopic adrenalectomy for unilateral hyperaldosteronism had a positive impact on hypertension

in 82 % at 12 months postoperatively. The prevalence of unilateral adrenal hyperplasia was higher than traditionally reported.

Adrenal venous sampling is the only approach capable of distinguishing unilateral from bilateral aldosterone overproduction.

Keywords: primary hyperaldosteronism, adrenalectomy, adrenal venous sampling, hypertension, adrenal adenoma, adrenal hyperplasia

Published: December 1, 2013  Show citation