c l i n i c a l f o l i o s : d i s c u s s i o n




Related narrative: Open Adrenalectomy for Aldosteronoma

Adrenalectomy for a small lesion like this is now most commonly done laparoscopically. A posterior approach is also a less invasive option. This case was done open because of the associated gynecological procedure. Large fibroids mitigated for an open hysterectomy.

It was once thought that most patients with hyperaldosteronism (Conn's syndrome) have a solitary unilateral adrenal cortical adenoma, but more careful evaluation now identifies a similar number who have bilateral adrenal hyperplasia. It is now thought that the hypertension seen in hyperaldosteronism is not solely due to the volume expansion secondary to sodium retention, but may also have a component of increased vascular resistance.

Patients are prepared for surgery with a several week course of spironolactone to regulate blood pressure and optimize potassium balance. Electrolyte abnormalities resolve quickly after excision of an adenoma, but blood pressure may take several months to return to normal. The cure rate after adrenalectomy is 70-90%.


Wilson: Williams Textbook of Endocrinology, 9th ed., Copyright 1998 W. B. Saunders Company: 595-597, 741-743.

This page was last modified on 24-Dec-2000.