Can primary hyperaldosteronism be treated surgically?

Treatment of unequivocal APA is by unilateral laparoscopic removal of the affected gland (adrenalectomy). Ideally this should involve only partial adrenalectomy where possible, with selective excision of the tumour alone, preserving the rest of the adrenal tissue. This procedure does not have a higher recurrence than removal of the whole affected adrenal gland and has the virtue of preserving normal adrenal tissue. Approximately 70-90% of procedures will result in long-term cure in APA. Surgery is not used in other causes of primary hyperaldosteronism where medical therapy with spironolactone is preferred (e.g. surgical cure in IHA is less than 20%).

Preceding surgery, medical therapy such as spironolactone and amiloride (see below) should be given for 4-6 weeks to control blood pressure and replenish potassium stores. Good blood pressure control pre-operatively predicts a better long-term result. Post-operatively, blood tests are carried out to check levels of the relevant hormones and potassium levels to assess the surgical result.

More detail about adrenal surgery can be found in the main 'Surgery' section.

Can primary hyperaldosteronism be treated medically?

This is used peri-operatively and for patients with:

  • tumours unsuitable for surgery
  • bilateral idiopathic adrenal hyperaldosteronism (IHA)
  • glucocorticoid-suppressible aldosteronism (GSA)

Spironolactone - An antagonist of aldosterone (i.e. it blocks aldosterone's action) corrects potassium levels (quickly) and blood pressure and blood pH (less quickly). In high doses it can inhibit testosterone production causing gynaecomastia (breast development in men), reduced libido and impotence in men, and irregular periods in women.

Amiloride™- A potassium sparing-diuretic. This rarely causes headaches, lethargy and nausea, and is used when patients are intolerant of spironolactone.

Dexamethasone - This is a glucocorticoid used to suppress ACTH release from the pituitary (see physiology section). By definition this is used in glucocorticoid-suppressible aldosteronism (GSA).

Other drugs used include:

  • antihypertensives - (drugs lowering blood pressure)
  • ACE inhibitors - specifically for IHA which is very sensitive to angiotensin II.