Aldosteronomas--state of the art

• Published in: The Surgical clinics of North America Vol. 89; no. 5; p. 1241
• Main Authors: McKenzie, Travis J, Lillegard, Joseph B, Young, Jr, William F, Thompson, Geoffrey B
• Format: Journal Article
• Language: English
• Published: United States 01.10.2009
• Subjects: Adrenal Cortex Neoplasms - complications; Adrenal Cortex Neoplasms - diagnostic imaging; Adrenal Cortex Neoplasms - pathology; Adrenal Cortex Neoplasms - surgery; Adrenal Glands - blood supply; Adrenal Glands - pathology; Adrenal Glands - surgery; Adrenalectomy - methods; Adrenocortical Adenoma - complications; Adrenocortical Adenoma - diagnostic imaging; Adrenocortical Adenoma - pathology; Adrenocortical Adenoma - surgery; Humans; Hyperaldosteronism - complications; Hyperaldosteronism - diagnostic imaging; Hyperaldosteronism - surgery; Hypertension - etiology; Tomography, X-Ray Computed
• ISSN: 1558-3171
• DOI: 10.1016/j.suc.2009.06.017

Primary aldosteronism (PA) is the most common cause of secondary hypertension in nonsmokers. Widespread screening of unselected hypertensives has identified PA in as many as 15% of patients. With such screening efforts using the PAC/PRA ratio and PAC, the widespread prevalence of the disease has become apparent while the relative percentage of APA has decreased. PA is confirmed by demonstrating lack of aldosterone suppressibility with sodium loading. Subtype evaluation is best achieved with high resolution CT scanning and AVS in the appropriate setting. In patients with PA and a unilateral source of aldosterone excess, laparoscopic adrenalectomy is the treatment of choice with excellent outcomes and low morbidity as compared with older open approaches. Patients with IHA, or those not amenable or agreeable to surgery, are best managed with a MR antagonist.