Unilateral adrenalectomy for aldosterone-producing adenoma in Hong Kong: outcomes and factors predicting resolution of hypertension

Abstract

Objective: To evaluate surgical outcomes of patients with aldosterone-producing adenoma (APA) over a 6-year period from 2009 to 2014 in Hong Kong, and to derive a new scoring system to predict cure of hypertension after surgery.

Methodology: This was a retrospective multi-centre study evaluating 104 APA patients from five major hospitals in Hong Kong. These patients were retrieved using database from Surgical Outcomes Monitoring and Improvement Programme (SOMIP). Their clinical characteristics and surgical outcomes were evaluated.

Results: Over a median follow-up period of 5 years, APA patients who had undergone adrenalectomy had an average decrease in systolic and diastolic blood pressure of 16.9 and 4.8 mm Hg respectively. Cure of hypokalaemia, cure of hypertension and improvement in hypertension occurred in 100%, 48.5% and 40% respectively. When a patient had two of the following three parameters, namely, female sex, duration of hypertension ≤5 years and number of anti-hypertensives ≤2, the sensitivity and specificity in achieving cure in hypertension was 79.6% and 70.6%, respectively. Surgical complications were uncommon.

Conclusions: Adrenalectomy resulted in resolution of hypokalaemia for all and cure of hypertension in half of the patients with APA. It was safe and effective in curing hyperaldosteronism.