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The Role Of Intra- and Postoperative Serum Aldosterone Levels Following Adrenalectomy For Primary Aldosteronism
Brian M Keuer1, Alejandro Ayala2, Peter A. Pinto3
1Georgetown University Hospital, Washington, DC;2National Institutes of Health, Bethesda, MD;3Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
Introduction: Despite undergoing adrenalectomy for unilateral primary aldosteronism (PA), some patients remain hypertensive. We report on the use of intra- and postoperative serum aldosterone as an indicator of resolution of hyperaldosteronism in patients undergoing laparoscopic adrenalectomy for unilateral PA.
Methods: Fourteen consecutive patients underwent laparoscopic adrenalectomy for PA between February 2004 and November 2005 at the National Institutes of Health. Diagnosis was obtained by adrenal vein sampling(AVS) in all patients. At the time of adrenalectomy, serum aldosterone levels were drawn at the division of the adrenal vein and 30, 60, 90, and 120 minutes after. Follow-up data was obtained from clinical charts or telephone contact.
Results: Ten of the 14 patients have complete follow-up data. Mean age at the time of adrenalectomy was 53.7 years. Nine (90%) patients had resolution of hypertension (defined as <140/90) at a mean follow-up of 13.7 months. The mean percent reduction of serum aldosterone level at 2 hours after adrenal vein division in these patients was 76.4%. One patient remained hypertensive at follow-up. Serum aldosterone level at 2 hours did not drop appropriately in this patient (12.9% increase). Further work-up consisting of repeat AVS and imaging confirmed an ectopic aldosteronoma.
Conclusions: This initial data suggests the utility of intra- and postoperative serum aldosterone levels following adrenalectomy for PA. Serum aldosterone levels that fall appropriately correlate with resolution of hypertension. Serum aldosterone levels that fail to drop immediately should prompt the surgeon to search for additional sources of hyperaldosteronism.
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