Long-term outcomes of unilateral adrenalectomy in patients with dominant-side adrenal hyperplasia

Introduction: Usual treatment for patients with aldosteroneproducing adrenal adenoma is adrenalectomy, whereas adrenal hyperplasia is generally treated medically. Selective adrenal venous sampling (AVS) has been adopted to differentiate between adenoma and hyperplasia. A previous ratio used in our institution for the diagnosis of adenoma proved to be too low. As a result, a disproportionate number of patients with a preoperative diagnosis of adenoma were operated and subsequently found to have hyperplasia. Materials and methods: This prospective study evaluated the long-term outcomes of unilateral laparoscopic adrenalectomy in the setting of lateralizing aldosterone hypersecretion caused by adrenal hyperplasia. Results: Twelve patients with unilateral excess aldosterone production due to hyperplasia underwent dominant side adrenalectomy. Long-term follow-up (mean 12 years) of these patients showed that blood pressure decreased from a mean of 163.4 ± 17.5/100 to 131.5 ± 9.7/80 mm Hg (p < 0.05), and the number of antihypertensive drugs decreased from 4.3 ± 0.7 to 2.2 ± 0.9 (p < 0.05). Mean potassium level increased from 3.7 to 4.2 mEq/L and the plasma aldosterone level decreased from 26.5 to 10.1 ng/dL. Conclusion: Dominant side adrenalectomy in patients with primary aldosteronism (PA) due to hyperplasia results in long-term clinical improvement. This procedure should be considered in selected patients with lateralization confirmed by venous sampling.