Outcome of adrenalectomy for Conn’s syndrome
Normal potassium levels are achieved in all patients cured of Conn’s syndrome, therefore all potassium supplements will be stopped after the operation.
If one had many years of high blood pressure, the structure (‘make up’) of blood vessels is expected to have been affected severely and such irreversible changes will persist after adrenal surgery. This explains why in some patients the blood pressure does not return to normal. Even though one might still have a degree of residual hypertension, the levels will not be as high and the risk of many of the long term-complications (e.g. stroke) is reduced .
Factors associated with favourable response after adrenalectomy
gender - female
normal body weight
duration of hypertension less than 5-6 years
preoperative use of two or fewer antihypertensive drugs
positive preoperative response to spironolactone
having one or no first-degree relative with hypertension.
Controversial benefits and indications for adrenalectomy.
If adrenal venous sampling demonstrates bilateral excess secretion of aldosterone, it is current practice to offer medical control of high blood pressure. Allegedly, removing the larger adrenal (as indicated on CT scan) or removing the adrenal showing the ‘dominant’ secretion of aldosterone (as demonstrated on adrenal venous sampling) remains beneficial. It is likely that in coming years this approach will gain more popularity.