Surgery is the mainstay of treatment for unilateral adrenal hyperplasia, aldosterone producing adenomas (APAs), adrenal carcinoma, ectopic ACTH, renin, and deoxycorticosterone secreting tumors.

Adrenal lesions producing excess aldosterone are treated mainly by laparoscopic adrenalectomy. Retroperitoneoscopic removal of adrenal glands in patients with primary hyperaldosteronism (Conn’s syndrome) is a safe, rapidly performed surgical procedure and can thus be considered as first choice option for treatment of both solitary adrenal adenomas and hyperplasia presenting with a clinically predominating nodule.^[1] Symptom resolution may take one to six months after the procedure.

Surgery for primary hyperaldosteronism is indicated in the following:^[2]

• Unilateral adrenal hyperplasia
• Aldosterone producing adenoma (APA)
• Adrenal carcinoma
• Ectopic ACTH
• Reninoma
• Deoxycorticosterone secreting tumors

Biochemical evidence of primary aldosteronism,. defined as all of the following present^[3]:

• plasma aldosterone concentration ≥15 ng/dL
• aldosterone-renin activity ratio ≥30 or aldosterone-renin concentration ratio ≥4.8
• suppressed renin

Surgery is contraindicated in the following situations:

• Hemodynamic instability
• Severe hypokalemia

Postoperative management of primary hyperaldosteronism includes the following:^[4]

• PRN use of anti-hypertensives and anti-hypokalemics
• Anti-hypokalemia can be continued if serum potassium is <3.0 meq/l
• PAC/PRA should be recorded immediately postoperatively on day one, to ensure surgical cure.
• Intra-venous saline load test (SLT) or a fludrocortisone suppression test (FST) can be conducted three months after surgery.

Good prognosis after adrenalectomy depends on:^[5]

• Good response to medical therapy with spironolactone
• Young age
• Decreased duration of hypertension
• Preoperative use of two or fewer antihypertensive agents