Clinical and biochemical outcomes of laparoscopic adrenalectomy in patients with Conn’s syndrome: experience from a tertiary referral center in Mexico
DOI:
https://doi.org/10.18203/2349-2902.isj20262469Keywords:
Primary aldosteronism, Conn's syndrome, Laparoscopic adrenalectomy, Secondary hypertension, Adrenal surgeryAbstract
Unilateral primary aldosteronism, also known as Conn's syndrome, is a potentially curable cause of secondary arterial hypertension. Laparoscopic adrenalectomy represents the treatment of choice in selected patients, there are few national reports regarding its clinical and perioperative outcomes. A retrospective, observational, single-center case series was conducted on patients diagnosed with unilateral primary aldosteronism who underwent laparoscopic adrenalectomy at the Department of General Surgery of the High Specialty Medical Unit No. 25, Northeast National Medical Center, Mexican Social Security Institute (IMSS), Monterrey, Nuevo León, Mexico, between January 2020 and December 2024. The mean age was 46.3 years, and 58.3% of the patients were male. Preoperative hypokalemia was present in 91.7% of cases, and the mean number of antihypertensive medications was 3. Postoperatively, complete success was observed in 75% and partial success in 25%, with no cases of biochemical or clinical persistence. Resolution of hypokalemia was documented in 100% of patients, along with a significant decrease in serum aldosterone levels and the aldosterone-renin ratio, as well as a substantial reduction in antihypertensive requirements. There were no conversions to open surgery or perioperative complications, with a mean hospital stay of 24 hours. The predominant histopathological diagnosis was adrenal adenoma 91.7%. In this cases series study, laparoscopic adrenalectomy demonstrated a high rate of clinical and biochemical success, an excellent perioperative safety profile, and adequate resolution of the metabolic alterations associated with Conn's syndrome. These findings support its role as the treatment of choice for patients with unilateral primary aldosteronism.
References
Adler GK, Stowasser M, Correa RR, Khan N, Kline G, McGowan MJ, et al. Primary aldosteronism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2025;110(9):2453-95.
Farah MH, Hegazi M, Firwana M, Abusalih M, Saadi S, Al-Kordi M, et al. A systematic review supporting the Endocrine Society clinical practice guideline on management of primary aldosteronism. J Clin Endocrinol Metab. 2025;110(9):e2833-44.
Williams TA, Lenders JWM, Mulatero P, Burrello J, Rottenkolber M, Adolf C, et al. Outcomes after adrenalectomy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort. Lancet Diabetes Endocrinol. 2017;5(9):689-99.
Reincke M, Bancos I, Mulatero P, Scholl UI, Stowasser M, Williams TA. Diagnosis and treatment of primary aldosteronism. Lancet Diabetes Endocrinol. 2021;9(12):876-92.
Yip L, Duh QY, Wachtel H, Jimenez C, Sturgeon C, Lee CR, et al. American Association of Endocrine Surgeons guidelines for adrenalectomy. JAMA Surg. 2022;157(10):870-900.
Turcu AF, Yang J, Vaidya A. Primary aldosteronism: a multidimensional syndrome. Nat Rev Endocrinol. 2022;18(11):665-82.
Vaidya A, Carey RM. Evolution of the primary aldosteronism syndrome: updating the approach. J Clin Endocrinol Metab. 2020;105(12):3771-83.
Hundemer GL, Leung AA, Kline GA, Brown JM, Turcu AF, Vaidya A. Biomarkers to guide medical therapy in primary aldosteronism. Endocr Rev. 2024;45(1):69-94.
Yang J, McCarthy J, Shah SS, Ng E, Shen J, Libianto R, et al. Challenges in diagnosing and managing the spectrum of primary aldosteronism. J Endocr Soc. 2024;8(7):bvae109.
Funder JW. Primary aldosteronism. Trends Cardiovasc Med. 2022;32(4):228-33.
Picado O, Whitfield BW, Khan ZF, Jeraq M, Farrá JC, Lew JI. Long-term outcome success after operative treatment for primary aldosteronism. Surgery. 2021;169(3):528-32.
Nardi WS, Toffolo M, Recalde M, Saban M, Schiavone M, Quildrian SD. Outcomes after laparoscopic adrenalectomy for unilateral primary aldosteronism. Medicina (B Aires). 2022;82(4):558-63.
Sawyer N, Glendenning P, Vasikaran SD, Page MM, van Schie G, Wong SL, et al. The Adrenal Vein Sampling Outcomes Study (AVOS): success rates following adrenalectomy for unilateral primary aldosteronism. Pathology. 2023;55(4):531-7.
Abdel-Aziz T, Abdelsalam A, Chung TT, Srirangalingam U, Hurel S, Conway G, et al. Short- and long-term outcomes of adrenalectomy for primary aldosteronism in a single UK center: rear-mirror view. Hormones (Athens). 2025;24:251-8.
Ben Abid F, Charfi N, Boussaa A, Chtourou L, Mnif MF, Abid M, et al. Predictors of successful outcome after adrenalectomy for unilateral primary aldosteronism. Front Endocrinol (Lausanne). 2023;14:1207266.
Miller BS, Gauger PG, Hammer GD, Doherty GM. Laparoscopic adrenalectomy: indications, techniques, and outcomes. Surg Clin North Am. 2019;99(4):721-35.
Conzo G, Musella M, Corcione F, De Palma M, Ferraro F, Palazzo A, et al. Laparoscopic adrenalectomy, a safe procedure for adrenal lesions: clinical outcomes and literature review. Int J Surg. 2020;76:70-82.
Walz MK, Alesina PF, Wenger FA, Koch JA, Neumann HPH, Petersenn S, et al. Posterior retroperitoneoscopic adrenalectomy—results of 560 procedures in 520 patients. Surgery. 2020;168(6):1099-105.
Monticone S, D'Ascenzo F, Moretti C, Williams TA, Veglio F, Gaita F, et al. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2018;6(1):41-50.
Hundemer GL, Curhan GC, Yozamp N, Wang M, Vaidya A. Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study. Lancet Diabetes Endocrinol. 2018;6(1):51-9.
Rossi GP, Auchus RJ, Brown M, Lenders JWM, Naruse M, Plouin PF, et al. An expert consensus statement on use of adrenal vein sampling for the subtyping of primary aldosteronism. Hypertension. 2014;63(1):151-60.
El Ghorayeb N, Mazzuco TL, Bourdeau I, Mailhot JP, Zhu PS, Thérasse E, et al. Basal and postadrenalectomy biochemical cure in unilateral primary aldosteronism diagnosed by CT without adrenal vein sampling. J Clin Endocrinol Metab. 2016;101(7):2713-20.
Downloads
Published
How to Cite
Issue
Section
