SURGERY FOR PRIMARY HYPERALDOSTERONISM - RELATED TUMOUR: LONG TERM OUTCOME AND CO-MORBIDITIES
Primary hyperaldosteronism (PH) caused by an aldosterone producing adrenal tumour is cured after adrenalectomy. However, long term follow-up is needed focusing on arterial hypertension and metabolic complications. A 69-year-old male was confirmed with PH at the age of 62. At that moment he had an 18-year history of high blood pressure (maximum 200/100 mmHg) in association with diabetes mellitus and hyperlipidemia. He developed hypopotassemia requiring spironolactone. No hypoaldosteronism was registered but a normalization of adrenal endocrine profile. While the patient was first evaluated for PH at the age of 62, a routine thyroid check-up showed multi-nodular enlargement with a large cyst on the right lobe. Six years later, the patient has moderate high blood pressure values controlled under daily 80 mg of telmisartan. This is a 49-year-old female with irrelevant family history who became hypertensive at the age of 37. At the age of 42, while she was investigated for performing a cholecystectomy, a left adrenal tumour of 1.2/0.9/0.9 cm was discovered at CT. Three years later she was investigated for secondary hypertension after associating mild hypopotassemia. A tumour production of aldosterone was linked with the adrenal mass. Currently, 4 years after the adrenal excision, biochemistry and endocrine panel is normal with residual high blood pressure controlled with low doses of calcium and beta adrenergic blockers. Surgery for adrenals in primary hyperaldosteronism is one elegant option which may cure the condition. A high index of suspicion and a systematic approach are useful in identifying and proving the diagnosis. Association with other endocrine disorders diversify the clinical appearance. Delaying the diagnosis and adrenalectomy decreases the chance of high blood pressure remission after adrenal removal.