Aldosterone deficiency after unilateral adrenalectomy for Conn's syndrome: a case report and literature review

Abstract

Introduction: Approximately 35% of cases of Conn's syndrome (primary aldosteronism) result from a solitary functioning adrenal adenoma, and these patients are best managed by adrenalectomy. Postoperative hypoaldosteronism after unilateral adrenalectomy is uncommon.

Case presentation: We present a case and literature review of hypoaldosteronism after unilateral adrenalectomy for Conn's syndrome, which demonstrates the insidious and sometimes delayed presentation.

Discussion: In this clinical case we summarize the previously published cases of post-adrenalectomy hypoaldosteronism based on a PUBMED and EBSCOhost search of all peer-reviewed publications (original articles and reviews) on this topic. A few cases of aldosterone insufficiency post-adrenalectomy for Conn's syndrome were identified. The etiological factors for prolonged selective suppression of aldosterone secretion after unilateral adrenalectomy remain unclear.

Conclusion: It is important to be aware of the risk of postoperative hypoaldosteronism in this patient population. Close postoperative follow-up is necessary and strongly recommended, especially in patients with certain risk factors. Patients may need mineralocorticoid supplementation during this period.

Keywords: Adrenalectomy; Aldosterone; Conn’s; Hypertension; Hypokalemia.

Fig. 1

CT image of left 1.8 cm adrenal nodule with an average attenuation of 2.6 Hounsfield units.

Fig. 2

Low power view (2× objective) of an adenoma with expansive smooth borders (yellow arrow) sharply demarcated from the adjacent normal adrenal cortex (black arrow).

Fig. 3

High power view (40× objective) demonstrating bland appearing large, lipid-rich cells composing most of the adenoma.