Purpose: Primary aldosteronism due to an adrenal cortical adenoma is
a surgically curable disease. However, hypertension is known to persist
postoperatively in many patients. The aim of this study was to determine the
factors influencing the long-term outcome of blood pressure after an
adrenalectomy for a primary aldosteronism and to evaluate the changing
pattern of renin and aldosterone. Methods: Forty-two cases of primary
aldosteronism, which were operated on and followed up at the Department of
Surgery, Seoul National University Hospital from January 1986 to June 2001
were included in this study. The subjects were classified into a
normotensive group and a hypertensive group and the two groups were compared
according to the clinical, biochemical and pathological parameters.
Results: After surgery, the aldosterone concentration was decreased
and the plasma renin activity was increased. During a mean follow-up period
of 28 months, 31 patients (73.8%) had a normal blood pressure without an
antihypertensive treatment. The significant risk factors for persistent
hypertension were a family history of hypertension, a long duration of
preoperative hypertension, a poor response of preoperative spironolactone.
The hypertensive group had a higher level of postoperative plasma renin
activity and an aldosterone concentration in the long-term follow-up period
after surgery. Conclusion: A family history of hypertension, the
duration of hypertension and the response to spironolactone were factors
influencing persistent hypertension after surgery for a primary
aldosteronism. A high level of plasma renin activity and aldosterone during
the follow-up period is related to the persistent hypertension. Therefore,
early detection and surgery for a primary aldosteronism would reduce the
preoperative cardiovascular changes and improve the postoperative outcome.
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