Prognosis

Patients undergoing unilateral adrenalectomy for unilateral PA

This procedure leads to cure of hypertension in 50% to 60% of carefully selected patients and improvement in all of the remainder.​[27][107][115][116][117]​​ BP typically normalizes or shows maximum improvement in 1 to 6 months after unilateral adrenalectomy, but can continue to fall for up to 1 to 2 years in some patients.[6] Primary aldosteronism (PA)is biochemically cured in 70% of fully worked-up patients, and improved in all remaining patients.[27][107][116]​​ Less than 20% of patients require equivalent or increased medication doses after surgery.[104]​ There is a consistent improvement in quality of life. Cohort studies have shown marked improvements in cardiovascular parameters (including left ventricular mass on echo).[61][125]

Recurrence of PA in those apparently cured after 12 months is uncommon. In patients with persistent (albeit improved) PA, hypertension may respond well to small doses of aldosterone antagonist medications, but caution is required as the levels of aldosterone have probably been substantially reduced.[6]

Patients undergoing treatment with aldosterone antagonist medications

Hypertension is improved and control achieved in the majority.[27][107][122] Hypokalemia, when present, is almost always corrected.

However, improvements aren't as dramatic as after unilateral adrenalectomy for lateralizing lesions. In cohort studies, the mean number of antihypertensive medications required did not fall as markedly, and there was less impressive improvement in echocardiographically derived left ventricular mass.[27][61]

Patients with FH-I undergoing treatment with glucocorticoid medications

Hypertension in familial hyperaldosteronism type I (FH-I) is frequently of early onset and may be severe enough to cause early death, usually from hemorrhagic stroke, unless specifically treated.[20][21] However, treatment with glucocorticoids, given in low doses that do not cause Cushingoid adverse effects, is usually highly effective at controlling hypertension (and thereby preventing stroke), with supplementary antihypertensives only occasionally required.[132]

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