Influence of Unilateral Adrenalectomy on Renin-Angiotensin-Aldosterone System in Primary Aldosteronism

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Abstract
In a study of 14 patients (11 Japanese and 3 white North Americans) with aldosterone-[Aldo]-producing tumor carried out within 2-4 wk after unilateral adrenalectomy, both plasma renin activity (PRA) and plasma Aldo concentration (PAC) increased almost normally with short-term Na depletion and upright posture. Aldo excretion rate (AER) also increased significantly with Na depletion, and was normally suppressed by Na loading. Highly significant correlations were observed between PRA and PAC (r = 0.89, P < 0.001) or AER (r = 0.88, P < 0.001) after operation, whereas there had been no such correlation before operation. Either physiological or laboratory findings were normalized or markedly improved in all cases although pathohistological diagnosis was made as adenomatous hyperplasia in 10 out of 11. These results indicate that within 4 wk of operation PRA and the remaining adrenal gland can almost normally respond to stimuli such as Na depletion and upright posture regardless of the amount of spironolactone given preoperatively.