SFE/SFHTA/AFCE consensus on primary aldosteronism, part 6: Adrenal surgery

Ann Endocrinol (Paris). 2016 Jul;77(3):220-5. doi: 10.1016/j.ando.2016.01.009. Epub 2016 Jun 11.


Treatment of primary aldosteronism (PA) aims at preventing or correcting hypertension, hypokalemia and target organ damage. Patients with lateralized PA and candidates for surgery may be managed by laparoscopic adrenalectomy. Partial adrenalectomy and non-surgical ablation have no proven advantage over total adrenalectomy. Intraoperative morbidity and mortality are low in reference centers, and day-surgery is warranted in selected cases. Spironolactone administered during the weeks preceding surgery controls hypertension and hypokalemia and may prevent postoperative hypoaldosteronism. In most cases, surgery corrects hypokalemia, improves control of hypertension and reduces the burden of pharmacologic treatment; in about 40% of cases, it resolves hypertension. However, success in controlling hypertension and reversing target organ damage is comparable with mineralocorticoid receptor antagonists. Informed patient preference with regard to surgery is thus an important factor in therapeutic decision-making.

Keywords: Adrenalectomy; Guiding factors; Hyperaldosteronism; Hyperaldostéronisme; Lignes directrices; Résultat thérapeutique; Surrénalectomie; Treatment outcome.

Publication types

  • Consensus Development Conference
  • Practice Guideline

MeSH terms

  • Adrenalectomy* / adverse effects
  • Adrenalectomy* / methods
  • France
  • Humans
  • Hyperaldosteronism / drug therapy
  • Hyperaldosteronism / surgery*
  • Hypertension / drug therapy
  • Hypertension / surgery
  • Hypokalemia / drug therapy
  • Hypokalemia / surgery
  • Intraoperative Complications
  • Laparoscopy
  • Mineralocorticoid Receptor Antagonists / therapeutic use
  • Postoperative Complications
  • Spironolactone / therapeutic use
  • Treatment Outcome


  • Mineralocorticoid Receptor Antagonists
  • Spironolactone