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Horm Metab Res 2010; 42(6): 440-445
DOI: 10.1055/s-0029-1246185
Review

© Georg Thieme Verlag KG Stuttgart · New York

Mineralocorticoid Antagonists Treatment Versus Surgery in Primary Aldosteronism

C. Catena1 , G. Colussi1 , A. Di Fabio1 , M. Valeri1 , L. Marzano1 , A. Uzzau1 , L. A. Sechi1
  • 1Internal Medicine, Hypertension Unit, Department of Experimental and Clinical Pathology and Medicine, and General Surgery, Department of Surgical Science, University of Udine, Udine, Italy
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Publication History

received 14.09.2009

accepted 22.12.2009

Publication Date:
29 January 2010 (online)

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Abstract

Recent evidence indicates a greater frequency of primary aldosteronism (PA) among patients with hypertension than the previously accepted prevalence. PA was once considered a relatively benign form of hypertension associated with low incidence of organ complications. Recent views, however, suggest that long-term exposure to increased aldosterone levels might result in cardiovascular, renal, and metabolic sequelae that occur independently of the blood pressure level. Cross-sectional comparisons with patients with essential hypertension have demonstrated that patients with PA are at higher risk of cardiovascular events, have more frequent left ventricular hypertrophy and diastolic dysfunction, have greater urinary albumin losses as a marker of a hemodynamic intrarenal adaptation, and are insulin resistant. Some of these findings have been corroborated by the results of short-term, follow-up studies where it was shown that unilateral adrenalectomy or treatment with mineralocorticoid receptor (MR) antagonists are effective in correcting hypertension and hypokalemia. Normalization of blood pressure and correction of hypokalemia, however, are not the only goals in managing PA and effective prevention of organ complications is mandatory in these patients. The relative efficacy of adrenalectomy and MR antagonists, in the long-term, on the cardiovascular, renal, and metabolic outcomes still needs evaluation, being the aldosterone-induced tissue damage the main factor that could justify the cost of increasing efforts in screening of disease and differentiation of subtypes. In this narrative review, we summarize the results obtained with either surgical or medical treatment of PA and outline the findings of long-term, prospective studies on the effects of treatment on cardiovascular and renal outcomes and on insulin sensitivity.

Key words

adrenalectomy - albuminuria - cardiovascular events - glomerular filtration rate - left ventricular hypertrophy - spironolactone

References

  • 1 Plouin PF, Amar L, Chatellier G. for the COMETE-Conn Study Group . Trends in the prevalence of primary aldosteronism, aldosterone-producing adenomas, and surgically correctable aldosterone-dependent hypertension.  Nephrol Dial Transplant. 2004;  19 774-777
    Search in Google Scholar
  • 2 Mulatero P, Stowasser M, Loh KC, Fardella CE, Gordon RD, Mosso L, Gomez-Sanchez CE, Veglio F, Young Jr WF. Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents.  J Clin Endocrinol Metab. 2004;  89 1045-1050
    Search in Google Scholar
  • 3 Young WF. Primary aldosteronism: renaissance of a syndrome.  Clinical Endocrinology. 2007;  66 607-618
    Search in Google Scholar
  • 4 Gordon RD. The challenge of more robust and reproducible methodology in screening for primary aldosteronism.  J Hypertens. 2004;  22 251-255
    Search in Google Scholar
  • 5 Stowasser M, Gordon RD, Gunasekera TG, Cowley DC, Ward G, Archibald C, Smithers BM. High rate of detection of primary aldosteronism, including surgically treatable forms, after non-selective screening of hypertensive patients.  J Hypertens. 2003;  21 2149-2157
    Search in Google Scholar
  • 6 Rossi GP, Bernini G, Caliumi C, Desideri G, Fabris B, Ferri C, Ganzaroli C, Giacchetti G, Letizia C, Maccario M, Mallamaci F, Mannelli M, Mattarello MJ, Moretti A, Palumbo G, Parenti G, Porteri E, Semplicini A, Rizzoni D, Rossi E, Boscaro M, Pessina AC, Mantero F. for the PAPY Study Investigators . A prospective study of the prevalence of primary aldosteronism in 1 125 hypertensive patients.  J Am Coll Cardiol. 2006;  48 2293-2300
    Search in Google Scholar
  • 7 Conn JW, Knopf RF, Nesbit RM. Clinical characteristics of primary aldosteronism from an analysis of 145 cases.  Am J Surg. 1964;  107 159-172
    Search in Google Scholar
  • 8 Laragh JH. Vasoconstriction-Volume analysis for understanding and treating hypertension: the use of renin and aldosterone profiles.  Am J Med. 1973;  55 261-274
    Search in Google Scholar
  • 9 Rossi GP, Boscaro M, Ronconi V, Funder JW. Aldosterone as a cardiovascular risk factor.  Trends Endocrinol Metab. 2005;  16 104-107
    Search in Google Scholar
  • 10 Green EL, Kren S, Hostetter TH. Role of aldosterone in the remnant kidney model in the rat.  J Clin Invest. 1996;  98 1063-1068
    Search in Google Scholar
  • 11 Hollenberg NK. Aldosterone in the development and progression of renal injury.  Kidney Int. 2004;  66 1-9
    Search in Google Scholar
  • 12 Catena C, Lapenna R, Baroselli S, Nadalini E, Colussi G, Novello M, Favret G, Melis A, Cavarape A, Sechi LA. Insulin sensitivity in patients with primary aldosteronism: a follow-up study.  J Clin Endocrinol Metab. 2006;  91 3457-3463
    Search in Google Scholar
  • 13 Rossi GP, Sechi LA, Giacchetti G, Ronconi V, Strazzullo P, Funder JW. Primary aldosteronism: cardiovascular, renal, and metabolic implications.  Trends Endocrinol Metab. 2008;  19 88-90
    Search in Google Scholar
  • 14 Born-Frontsberg E, Reincke M, Beuschlein F, Quinkler M. Tumor size of Connâ's adenoma and comorbidities.  Horm Metab Res. 2009;  41 785-788
    Search in Google Scholar
  • 15 Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A, Palensky J, Wittes J. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators.  N Engl J Med. 1999;  341 709-717
    Search in Google Scholar
  • 16 Pitt B, Remme W, Zannad F, Neaton J, Martinez F, Roniker B, Bittman R, Hurley S, Kleiman J, Gatlin M. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction.  N Engl J Med. 2003;  348 1309-1321 Erratum: N Engl J Med 2003; 348: 2271
    Search in Google Scholar
  • 17 Sechi LA, Catena C. The dual role of the kidney in primary aldosteronism: key determinant in rescue from volume expansion and persistence of hypertension.  Am J Kidney Dis. 2009;  54 594-597
    Search in Google Scholar
  • 18 Sawka AM, Young Jr WF, Thompson GB, Grant CS, Farley DR, Leibson C, van Herdeen JA. Primary aldosteronism: factors associated with normalization of blood pressure after surgery.  Ann Intern Med. 2001;  135 258-261
    Search in Google Scholar
  • 19 Dluhy RG. Prevalence and Conn-sequences of primary aldosteronism.  Am J Kidney Dis. 2007;  49 566-568
    Search in Google Scholar
  • 20 Rossi GP, Pessina AC, Heagerty AM. Primary aldosteronism: an update on screening, diagnosis, and treatment.  J Hypertens. 2008;  26 613-621
    Search in Google Scholar
  • 21 Rossi GP, Pessina AC, Mantero F. More fuel to the debate on the epidemics of primary aldosteronism.  Hypertension. 2008;  51 e1-e2
    Search in Google Scholar
  • 22 Kaplan NM. Primary aldosteronism: an update on screening, diagnosis, and treatment.  J Hypertens. 2008;  26 1708-1709
    Search in Google Scholar
  • 23 Kaplan NM. Déjà vu for primary aldosteronism.  Lancet. 2008;  371 1890-1891
    Search in Google Scholar
  • 24 Takeda R, Matsubara T, Miyamori I, Hatakeyama H, Morise T. Vascular complications in patients with aldosterone producing adenoma in Japan: comparative study with primary hypertension.  J Endocrinol Invest. 1995;  18 370-373
    Search in Google Scholar
  • 25 Miro O, Pastor P, Pedrol E, Mallofre C, Graiu JM, Cardellach F. Cerebral vascular complications in Connâ's disease: report of two cases.  Neurologia. 1995;  10 209-211
    Search in Google Scholar
  • 26 Nishimura M, Uzu T, Fujii T, Kuroda S, Nakamura S, Inenaga T, Kimura J. Cardiovascular complications in patients with primary aldosteronism.  Am J Kidney Dis. 1999;  33 262-266
    Search in Google Scholar
  • 27 Porodko M, Auer J, Eber B. Connâ's syndrome and atrial fibrillation.  Lancet. 2001;  357 1293-1294
    Search in Google Scholar
  • 28 Milliez P, Girerd X, Plouin PF, Blacher J, Safar ME, Mourad JJ. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism.  J Am Coll Cardiol. 2005;  45 1243-1248
    Search in Google Scholar
  • 29 Catena C, Colussi GL, Nadalini E, Chiuch E, Baroselli S, Lapenna R, Sechi LA. Cardiovascular outcomes in patients with primary aldosteronism after treatment.  Arch Intern Med. 2008;  168 80-85
    Search in Google Scholar
  • 30 Brilla CG, Weber KT. Mineralocorticoid excess, dietary sodium, and myocardial fibrosis.  J Lab Clin Med. 1992;  120 893-901
    Search in Google Scholar
  • 31 Young M, Fullerton M, Dilley R, Funder J. Mineralocorticoids, hypertension, and cardiac fibrosis.  J Clin Invest. 1994;  93 2578-2583
    Search in Google Scholar
  • 32 Young M, Head G, Funder J. Determinants of cardiac fibrosis in experimental hypermineralocorticoid states.  Am J Physiol. 1995;  269 E657-E662
    Search in Google Scholar
  • 33 Rossi GP, Di Bello V, Ganzaroli C, Sacchetto A, Cesari M, Bestini A, Giorni D, Scognamiglio R, Mariani M, Pessina AC. Excess aldosterone is associated with alterations of myocardial texture in primary aldosteronism.  Hypertension. 2002;  40 23-27
    Search in Google Scholar
  • 34 Rossi GP, Sacchetto A, Pavan E, Palatini P, Graniero GR, Canali C, Pessina AC. Remodeling of the left ventricle in primary aldosteronism due to Connâ's adenoma.  Circulation. 1997;  95 1471-1478
    Search in Google Scholar
  • 35 Catena C, Colussi GL, Lapenna R, Nadalini E, Chiuch A, Gianfagna P, Sechi LA. Long-term cardiac effects of adrenalectomy or mineralocorticoid antagonists in patients with primary aldosteronism.  Hypertension. 2007;  50 911-918
    Search in Google Scholar
  • 36 Mottram PM, Haluska B, Leano R, Cowley D, Stowasser M, Marwick TH. Effect of aldosterone antagonism on myocardial dysfunction in hypertensive patients with diastolic heart failure.  Circulation. 2004;  110 558-565
    Search in Google Scholar
  • 37 Pitt B, Reichek N, Willenbrock R, Zannad F, Phillips RA, Roniker B, Kleiman J, Krazuse S, Burns D, Williams GH. Effects of eplerenone, enalalpril, and eplerenone/enelapril in patients with essential hypertension and left ventricular hypertrophy: the 4E-left ventricular hypertrophy study.  Circulation. 2003;  108 1831-1838
    Search in Google Scholar
  • 38 Blacher J, Amah G, Girerd X. Association between increased plasma levels of aldosterone and decreased systemic arterial compliance in subjects with primary hypertension.  Am J Hypertens. 1997;  10 1326-1334
    Search in Google Scholar
  • 39 Taddei S, Virdis A, Mattei P, Salvetti A. Vasodilation to acetylcholine in primary and secondary forms of human hypertension.  Hypertension. 1993;  21 929-933
    Search in Google Scholar
  • 40 Blasi ER, Rocha R, Rudolph AE, Blomme EA, Polly ML, McMahon EG. Aldosterone/salt induces renal inflammation and fibrosis in hypertensive rats.  Kidney Int. 2003;  63 1791-1800
    Search in Google Scholar
  • 41 Rocha R, Chander PN, Khanna K, Zuckerman A, Stier Jr CT. Mineralocorticoid blockade reduces vascular injury in stroke-prone hypertensive rats.  Hypertension. 1998;  31 451-458
    Search in Google Scholar
  • 42 Ibrahim HN, Hostetter TH. Aldosterone in progressive renal disease.  Semin Nephrol. 2001;  21 573-579
    Search in Google Scholar
  • 43 Epstein M. Aldosterone as a mediator of progressive renal disease: pathogenetic and clinical implications.  Am J Kidney Dis. 2001;  37 677-688
    Search in Google Scholar
  • 44 Sato A, Hayashi K, Naruse M, Saruta T. Effectiveness of aldosterone blockade in patients with diabetic nephropathy.  Hypertension. 2003;  41 64-68
    Search in Google Scholar
  • 45 Epstein M, Williams GH, Weinberger M, Lewin A, Krause S, Mukherjee R, Patni R, Beckerman B. Selective aldosterone blockade with eplerenone reduces albuminuria in patients with type 2 diabetes.  Clin J Am Soc Nephrol. 2006;  1 940-951
    Search in Google Scholar
  • 46 Schjoedt KJ, Rossing K, Juhl TR, Boomsma F, Rossing P, Tarnow L, Parving HH. Beneficial impact of spironolactone in diabetic nephropathy.  Kidney Int. 2005;  68 2829-2836
    Search in Google Scholar
  • 47 Bianchi S, Bigazzi R, Campese VM. Antagonists of aldosterone and proteinuria in patients with CKD: an uncontrolled pilot study.  Am J Kidney Dis. 2005;  46 45-51
    Search in Google Scholar
  • 48 Danforth Jr DN, Orlando MM, Bartter FC, Javadpour N. Renal changes in primary aldosteronism.  J Urol. 1977;  117 140-144
    Search in Google Scholar
  • 49 Beevers DG, Brown JJ, Ferriss JB, Fraser R, Lever AF, Robertson JI, Tree M. Renal abnormalities and vascular complications in primary aldosteronism: evidence of tertiary hyperaldosteronism.  Q J Med. 1976;  45 401-410
    Search in Google Scholar
  • 50 Bravo EL, Fouad-Tarazi FM, Tarazi RC, Pohl M, Gifford RW, Vidt DG. Clinical implications of primary aldosteronism with resistant hypertension.  Hypertension. 1988;  11 207-211
    Search in Google Scholar
  • 51 Blumenfeld JD, Sealey JE, Schlussel Y, Vaughan D, Sos TA, Atlas SA, Muller FB, Acevedo R, Ulick S, Laragh JH. Diagnosis and treatment of primary aldosteronism.  Ann Intern Med. 1994;  121 877-885
    Search in Google Scholar
  • 52 Rossi GP, Bernini G, Desideri G, Fabris B, Ferri C, Giacchetti G, Letizia C, Maccario M, Mannelli M, Matterello MJ, Montemurro D, Palombo G, Tizzoni D, Rossi E, Pessina AC, Mantero F. Renal damage in primary aldosteronism. Results of the PAPY study.  Hypertension. 2006;  48 232-238
    Search in Google Scholar
  • 53 Catena C, Colussi GL, Nadalini E, Chiuch A, Baroselli S, Lapenna R, Sechi LA. Relationships of plasma renin levels with renal function in patients with primari aldosteronism.  Clin J Am Soc Nephrol. 2007;  2 722-731
    Search in Google Scholar
  • 54 Reincke M, Rump LC, Quinkler M, Hahner S, Diederich S, Lorenz R, Seufert J, Schirpenbach C, Beuschlein F, Bidlingmaier M, Meisinger C, Holle R, Endres S. Risk factors associated with low glomerular filtration rate in primary aldosteronsim.  J Clin Endocrinol Metab. 2009;  94 869-875
    Search in Google Scholar
  • 55 Sechi LA, Novello M, Lapenna R, Baroselli S, Nadalini E, Colussi GL, Catena C. Long-term renal outcomes in patients with primary aldosteronism.  JAMA. 2006;  295 2638-2645
    Search in Google Scholar
  • 56 Ribstein J, Du Cailar G, Fesler P, Mimran A. Relative glomerular hyperfiltration in primary aldosteronism.  J Am Soc Nephrol. 2005;  16 1320-1325
    Search in Google Scholar
  • 57 Sechi LA, Di Fabio A, Bazzocchi M, Uzzau A, Catena C. Intrarenal hemodynamics in primary aldosteronism before and after treatment.  J Clin Endocrinol Metab. 2009;  94 1191-1197
    Search in Google Scholar
  • 58 Hall JE, Granger JP, Smith Jr MJ, Premen AJ. Role of hemodynamics and arterial pressure in aldosterone “escape”.  Hypertension. 1984;  6 I183-I192
    Search in Google Scholar
  • 59 Dworkin LD, Hostetter TH, Renne HG, Brenner BM. Hemodynamic basis for glomerular injury in rats with desoxycorticosterone-salt hypertension.  J Clin Invest. 1984;  73 1448-1461
    Search in Google Scholar
  • 60 Uhrenholt TR, Schjerning J, Hansen PB, Norregaard R, Jensen BL, Sorensen GL, Skott O. Rapid inhibition of vasoconstriction in renal afferent arterioles by aldosterone.  Circ Res. 2003;  93 1258-1266
    Search in Google Scholar
  • 61 Conn JW. Hypertension, the potassium ion and impaired carbohydrate intolerance.  N Engl J Med. 1965;  273 1135-1143
    Search in Google Scholar
  • 62 The Expert Committee on the Diagnosis Classification on Diabetes Mellitus . Report of the Expert Committee on the Diagnosis and Classification on Diabetes Mellitus.  Diabetes Care. 2003;  26 ((Suppl 1)) S5-S20
    Search in Google Scholar
  • 63 Widimsky Jr J, Strauch B, Sindelka G, Skrha J. Can primary hyperaldosteronism be considered as a specific form of diabetes mellitus?.  Physiol Res. 2001;  50 603-607
    Search in Google Scholar
  • 64 Haluzik M, Sindelka G, Widimsky Jr J, Prazny M, Zelinka T, Skrh J. Serum leptin levels in patients with primary hyperaldosteronism before and after treatment: relationships to insulin sensitivity.  J Hum Hypertens. 2002;  16 41-45
    Search in Google Scholar
  • 65 Sindelka G, Widimsky J, Haas T, Prazny M, Hilgertova J, Skrha J. Insulin action in primary aldosteronism before and after surgical or pharmacological treatment.  Exp Clin Endocrinol Diabetes. 2000;  108 21-25
    Search in Google Scholar
  • 66 Strauch B, Widimsky J, Sindelka G, Skhra J. Does the treatment of primary hyperaldosteronism influence glucose tolerance.  Physiol Res. 2003;  52 503-506
    Search in Google Scholar
  • 67 Skrha J, Haas T, Sindelka G, Prazny M, Widimsky J, Cibula D, Svacina S. Comparison of the insulin action parameters from hyperinsulinemic clamps with homeostasis model assessment and QUICKI indexes in subjects with different endocrine disorders.  J Clin Endocrinol Metab. 2004;  89 135-141
    Search in Google Scholar
  • 68 Widimsky J, Sindelka G, Haas T, Prazny M, Hilgertova J, Skrha J. Impaired insulin action in primary hyperaldosteronism.  Physiol Res. 2000;  49 241-244
    Search in Google Scholar
  • 69 Shimamoto K, Shiiki M, Ise T, Miyazaki Y, Higashiura K, Fukuoka M, Hirata A, Masuda A, Nagakawa M, Iimura O. Does insulin resistance participate in an impaired glucose tolerance in primary aldosteronism?.  J Hum Hypertens. 1994;  8 755-759
    Search in Google Scholar
  • 70 Ishimori M, Takeda N, Okumura S, Murai T, Inouye H, Yasuda K. Increased insulin sensitivity in patients with aldosterone producing adenoma.  Clin Endocrinol. 1994;  41 433-438
    Search in Google Scholar
  • 71 Fallo F, Veglio F, Bertello C, Sonino N, Della Mea P, Ermani M, Rabbia F, Federspil G, Mulatero P. Prevalence and characteristics of the metabolic syndrome in primary aldosteronism.  J Clin Endocrinol Metab. 2006;  91 454-459
    Search in Google Scholar
  • 72 Giacchetti G. Aldosterone as a key mediator of the cardiometabolic syndrome in primary aldosteronism: an observational study.  J Hypertens. 2007;  25 177-186
    Search in Google Scholar
  • 73 Colussi GL, Catena C, Lapenna R, Nadalini E, Chiuch A, Sechi LA. Insulin resistance and hyperinsulinemia are related to plasma aldosterone levels in hypertensive patients.  Diabetes Care. 2007;  30 2349-2354
    Search in Google Scholar
  • 74 Krug AW, Ehrhart-Bornstein M. Adrenocortical dysfunction in obesity and the metabolic syndrome.  Horm Metab Res. 2008;  40 515-517
    Search in Google Scholar
  • 75 Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M, Young WF, Montori VM. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an Endocrine Society clinical practice guideline.  J Clin Endocrinol Metab. 2008;  93 3266-3281
    Search in Google Scholar
  • 76 Letavernier E, Peyrard S, Amar L, Zinzindohoue F, Fiquet B, Plouin PF. Blood pressure outcome of adrenalectomy in patients with primary hyperaldosteronism with or without unilateral adenoma.  J Hypertens. 2008;  26 1816-1823
    Search in Google Scholar
  • 77 Brown JJ, Davies DL, Ferriss JB, Fraser R, Haywood E, Lever AF Robertson JI. Comparison of surgery and prolonged spironolactone therapy in patients with hypertension, aldosterone excess, and low plasma renin.  Br Med J. 1972;  2 729-734
    Search in Google Scholar
  • 78 Kater CE, Biglieri EG, Schambelan M, Arteaga E. Studies of impaired aldosterone response to spironolactone-induced renin and potassium elevation in adenomatous but not hyperplastic primary aldosteronism.  Hypertension. 1983;  5 V115-V121
    Search in Google Scholar
  • 79 Lim PO, Jung RT, MacDonald TM. Raised aldosterone to renin ratio predicts antihypertensive efficacy of spironolactone: a prospective cohort follow-up study.  Br J Clin Pharmacol. 1999;  48 756-760
    Search in Google Scholar
  • 80 Ghose RP, Hall PM, Bravo EL. Medical management of aldosterone-producing adernomas.  Ann Intern Med. 1999;  131 105-108
    Search in Google Scholar
  • 81 Sywak M, Pasieka JL. Long-term follow-up and cost benefit of adrenalectomy in patients with primary hyperaldosteronism.  Br J Surg. 2002;  89 1587-1593
    Search in Google Scholar
  • 82 Karagiannis A, Tziomalos K, Papageorgiou A, Kakafika AI, Pagourelias ED, Anagnostis P, Athyros VG, Mikhailidis DP. Spironolactone versus eplerenone for the treatment of idiopathic hyperaldosteronism.  Expert Opin Pharmacother. 2008;  9 509-515
    Search in Google Scholar
  • 83 Obara T, Ito Y, Okamoto T, Kanaji Y, Yamashita T, Aiba M, Fujimoto Y. Risk factors associated with postoperative persistent hypertension in patients with primary aldosteronism.  Surgery. 1992;  112 987-993
    Search in Google Scholar
  • 84 Stowasser M, Klemm SA, Tunny TJ, Storie WJ, Rutherford JC, Gordon RD. Response to unilateral adrenalectomy for aldosterone-producing adenoma: effect of potassium levels and angiotensin responsiveness.  Clin Exp Pharmacol Physiol. 1994;  21 319-322
    Search in Google Scholar
  • 85 Celen O, O’Brien MJ, Melby JC, Beazley RM. Factors influencing outcome of surgery for primary aldosteronism.  Arch Surg. 1996;  131 646-650
    Search in Google Scholar
  • 86 Lo CY, Tam PC, Kung AW, Lam KS, Wong J. Primary aldosteronism. Results of surgical treatment.  Ann Surg. 1996;  224 125-130
    Search in Google Scholar
  • 87 Proye CA, Mulliez EA, Carnaille BM, Lecomte-Houcke M, Decoulx M, Wemeau JL, LefebvreJ, Racadot A, Ernst O, Huglo D, Carre A. Essential hypertension: first reason for persistent hypertension after unilateral adrenalectomy for primary aldosteronism?.  Surgery. 1998;  124 1128-1133
    Search in Google Scholar
  • 88 Horita Y, Inenaga T, Nakahama H, Ishibashi-Ueda H, Kawano Y, Nakamura S, Horio T, Okuda N, Ando M, Takishita S. Cause of residual hypertension after adrenalectomy in patients with primary aldosteronism.  Am J Kidney Dis. 2001;  37 884-889
    Search in Google Scholar
  • 89 Meria P, Kempf BF, Hermieu JF, Plouin PF, Duclos J. Laparoscopic management of primary aldosteronism: clinical experience with 212 cases.  J Urol. 2003;  169 32-35
    Search in Google Scholar
  • 90 Lumachi F, Ermani M, Basso SM, Armanini D, Iacobone M, Favia G. Long-term results of adrenalectomy in patients with aldosterone-producing adenomas: multivariate analysis of factors affecting unresolved hypertension and review of the literature.  Am Surg. 2005;  71 864-869
    Search in Google Scholar
  • 91 Meyer A, Brabant G, Behrend M. Long-term follow-up after adrenalectomy for primary aldosteronism.  World J Surg. 2005;  29 155-159
    Search in Google Scholar

Correspondence

L. A. SechiMD 

Clinica Medica, University of Udine

Department of Experimental and Clinical Pathology and Medicine (DPMSC)

Piazzale S. Maria della

­Misericordia 1

33100 Udine

Italy

Phone: +39/0432/559 804

Fax: +39/0432/420 97

Email: sechi@uniud.it