The long-term effect of
adrenalectomy on
aldosterone-producing
adenomas of the adrenal gland is controversially discussed. The aim of this study was to analyze the long-term course, with special consideration of factors of persisting
hypertension after endoscopic
adrenalectomy, for
Conn's syndrome. Between February 1994 and March 2004, 40 patients with
Conn's syndrome underwent endoscopic
adrenalectomy. Data were recorded prospectively.
Adrenalectomy was carried out unilaterally in all patients. Twenty-three patients (57.5%) were women; the median age was 51.7 (31.2-71.4) years. Preoperatively, all patients presented with arterial
hypertension persisting over a median period of 84 (5-240) months; 76.3 per cent of the patients had previously been treated with an
aldosterone antagonist, and 85 per cent with specific
antihypertensives, whereas 52.6 per cent of all patients were under
therapy with
potassium compounds at the time of admission. After a median follow-up of 45 (7-114) months,
potassium substitution was discontinued in 100 per cent of patients, and the
aldosterone antagonist was discontinued in 94.7 per cent of patients. In 60.5 per cent of patients, the specific
antihypertensive drugs were reduced. Patients with a reduction in
antihypertensive medication had, compared with patients without a reduction, a shorter preoperative duration of arterial
hypertension and a lower level of serum
aldosterone, and were younger. Endoscopic
adrenalectomy for
Conn's syndrome leads to an immediate normalization of the electrolyte balance postoperatively, whereas
hypertension resolves in 60.5 per cent of patients in the long-term course. Thus, the coexistence of
essential hypertension or, respectively, a long duration of preoperative
hypertension with associated renovascular alterations are of significance for the long-term result.