Primary
aldosteronism consists of a mixture of subgroups. The operative treatment is successful only in cases of
aldosterone-producing
neoplasia (and in rare cases of primary unilateral
hyperplasia); all other cases should be treated medically. The aim of this study was to determine if
aldosterone-producing
neoplasia had been successfully differentiated from the other subgroups and the outcome of operative treatment. Altogether 29 patients with primary
aldosteronism were operated on between January 1, 1979 and December 31, 1993. Patient charts were reviewed retrospectively. The follow-up data were collected from the patients' charts, and all patients were contacted to obtain recent blood pressure and serum
potassium values. The patients were asked about symptoms related to
hyperaldosteronism. If any suspicion of recidive
aldosteronism was present, patients were carefully reexamined by hormonal tests and computed tomography (CT). A total of 27 patients had unilateral
adenoma, 1 patient had
hyperplasia, and 1 patient had an
aldosterone-producing cortical
carcinoma. There was no operative mortality or morbidity. The serum
potassium level had normalized in all patients. Mean follow-up time was 76 months. One patient died during the follow-up from
cholangiocarcinoma; 11 patients (41%) were cured by the operation, 10 patients (37%) have a mild but medicated
hypertension, and in the remaining 22% the
hypertension persisted but was well controlled by the medication. Of the 29 patients, 28 were correctly diagnosed as having an
aldosterone-producing
neoplasm. Basic hormonal studies and CT can be used effectively to differentiate
aldosterone-producing
neoplasia from
hyperplasia in most cases.