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      Adrenalectomy in Primary Aldosteronism: A Long-Term Follow-Up Study

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          Abstract

          The effect of unilateral adrenalectomy in primary aldosteronism was analyzed in 38 patients with unilateral adenoma, 12 cases with idiopathic bilateral hyperplasia and 1 patient suffering from an aldosterone-producing carcinoma. Responses to surgery differed markedly. In all 38 adenoma cases plasma aldosterone dropped to normal levels and remained within normal range during a mean follow-up period of 75 ± 12 months. 23 (61 %) of these patients became normotensive without medication and thus could be classified as definitely cured. 34% (13 patients) improved (normotensive under medical treatment) and only 2 cases (5 %) remained hypertensive despite sufficient medical treatment. In the hyperplasia group, however, the effect of adrenalectomy was disappointing. None of these subjects showed a long-lasting normalization of aldosterone secretion. A temporary remission for no more than 3–4 months was achieved in only 3 patients. In a fourth case with macronodular hyperplasia, primary aldosteronism relapsed after a 6-year period of normal blood pressure and aldosterone values. Therefore, 6 years after adrenalectomy no hyperplasia patient was definitely cured in contrast to 61 % of the adenoma cases. The problems in the management of hypertension in adrenal hyperplasia are furthermore documented by a poorer blood pressure control despite antihypertensive medication and a high rate of vascular complications. During the follow-up, 3 of 12 hyperplasia patients experienced a cerebrovascular event and 1 a myocardial infarction.

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          Author and article information

          Journal
          CRD
          Cardiology
          10.1159/issn.0008-6312
          Cardiology
          S. Karger AG
          978-3-8055-4079-7
          978-3-318-00139-6
          0008-6312
          1421-9751
          1985
          1985
          11 November 2008
          : 72
          : Suppl 1
          : 107-116
          Affiliations
          aDepartment of Internal Medicine, University Hospital, Zürich, Switzerland; bMedical Policlinic, University of Münster, FRG
          Article
          173955 Cardiology 1985;72:107–116
          10.1159/000173955
          3902226
          © 1985 S. Karger AG, Basel

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          Page count
          Pages: 10
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