Primary Hyperaldosteronism: The Role of the General Surgeons in Diagnosis and Treatment

Abstract

Primary hyperaldosteronism (PA) is the cause of endocrine hypertension, which commonly occurs in young patients with uncontrolled hypertension that leads to worsening cardiovascular-related mortality. Patients suspected of developing PA should have their plasma aldosterone concentration and plasma renin activity (PRA) assessed for screening purposes. After verifying the diagnosis of PA, adrenal venous sample (AVS) is the gold standard diagnostic technique for differentiating unilateral from bilateral disease. Since adrenalectomy may benefit patients with unilateral disease, laparoscopic adrenalectomy, a minimally invasive surgical approach that provides better postoperative outcomes than open surgery, has become the standard treatment for unilateral PA. Laparoscopic adrenalectomy resulted in a 53% cure rate of hypertension after surgery, as well as all patients had improved hypertension control, including the remission of hypokalemia. The conventional laparoscopic adrenalectomy approaches are transperitoneal and retroperitoneal, with similar postoperative outcomes. However, for general surgeons with limited laparoscopic adrenalectomy experience, the transperitoneal technique may offer an advantage over the retroperitoneal approach in terms of faster learning curve time, better surgical anatomy view, and the ability to resect adrenal tumors larger than 5 cm. This chapter focuses on the diagnosis and treatment of PA from the general surgeon’s perspective.