The Lingering Battle of Persistent Hypoaldosteronism Following Adrenalectomy for Primary Aldosteronism:
A Case Report
DOI:
https://doi.org/10.15605/JAFES.041.01.5151Keywords:
hypoaldosteronism, adrenalectomy, unilateral primary aldosteronism, hyperkalemiaAbstract
Persistent hypoaldosteronism post-adrenalectomy for unilateral primary aldosteronism is not uncommon and should be anticipated in patients with risk factors for development of such condition. Most cases of hypoaldosteronism post-adrenalectomy are transient. However, persistent hypoaldosteronism may occur as a result of delayed recovery of contralateral zona glomerulosa suppression, requiring mineralocorticoid replacement for the prevention or treatment of life-threatening hyperkalemia.
Downloads
References
Insufficiency causing hyperkalemia in primary aldosteronism after adrenalectomy. J Clin Endocrinol Metab. 2012;97(11):3965-73. https://pubmed.ncbi.nlm.nih.gov/22893716 https://doi.org/10.1210/jc.2012-2234
Park KS, Kim JH, Ku EJ, et al. Clinical risk factors of postoperative hyperkalemia after adrenalectomy in patients with aldosterone-producing adenoma. Eur J Endocrinol. 2015;172(6):725-31. https://pubmed.ncbi.nlm.nih.gov/25766046 https://doi.org/10.1530/EJE-15-0074
Chiang WF, Cheng CJ, Wu ST, et al. Incidence and factors of post-adrenalectomy hyperkalemia in patients with aldosterone producing adenoma. Clin Chim Acta. 2013;424:114-8. https://pubmed.ncbi.nlm.nih.gov/23727469 https://doi.org/10.1016/j.cca.2013.05.017
Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: Case detection, diagnosis, and treatment: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2016;101(5):1889-916. https://pubmed.ncbi.nlm.nih.gov/2693439 https://doi.org/10.1210/jc.2015-4061
Biglieri EG, Slaton PE Jr, Silen WS, Galante M, Forsham PH. Postoperative studies of adrenal function in primary aldosteronism. J Clin Endocrinol Metab. 1966;26(5):553-8. https://pubmed.ncbi.nlm.nih.gov/4287160 https://doi.org/10.1210/jcem-26-5-553
Mermejo LM, Elias PCL, Molina CAF, et al. Early renin recovery after adrenalectomy in aldosterone-producing adenomas: A prospective study. Horm Metab Res. 2022;54(4):224-31. https://pubmed.ncbi.nlm.nih.gov/35413743 https://doi.org/10.1055/a-1778-4002
Hajmomenian HR. Hyperkalemia following unilateral adrenalectomy for adrenal adenoma. Proc UCLA Health. 2013;17. https://escholarship.org/uc/item/2n7208zw
Mustaqeem R, Arif A. Renal tubular acidosis. StatPearls. Treasure Island (FL): StatPearls Publishing; 2026.
Hyland K, Perkins J. Persistent hyperkalemia status post-adrenalectomy for primary aldosteronism. Endocr Pract. https://doi.org/10.4158/EP15812.CR
Angus LM, Yang J, Cheung AS. Persistent hypoaldosteronism post-adrenalectomy for primary aldosteronism: A role for pre-operative spironolactone? Endocrinol Diabetes Metab Case Rep. 2021;2021:21-0137. https://pubmed.ncbi.nlm.nih.gov/34695011
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8558879 https://doi.org/10.1530/EDM-21-0137
Wada N, Baba S, Sugawara H, et al. Prolonged postoperative hypoaldosteronism related to hyperkalemia in patients with aldosterone-producing adenoma. Endocr J. 2023;70(9):917-24. https://pubmed.ncbi.nlm.nih.gov/37423737 https://doi.org/10.1507/endocrj.EJ23-0174
Tahir A, McLaughlin K, Kline G. Severe hyperkalemia following adrenalectomy for aldosteronoma: Prediction, pathogenesis and approach to clinical management: A case series. BMC Endocr Disord. 2016;16(1):43. https://pubmed.ncbi.nlm.nih.gov/27460219
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4962422 https://doi.org/10.1186/s12902-016-0121-y Rossi GP, Bernini G, Desideri G, et al. Renal damage in primary aldosteronism: Results of the PAPY Study. Hypertension. 2006;48(2):232-8. https://pubmed.ncbi.nlm.nih.gov/16801482 https://doi.org/10.1161/01.HYP.0000230444.01215.6a
.Shariq OA, Bancos I, Cronin PA, et al. Contralateral suppression of aldosterone at adrenal venous sampling predicts hyperkalemia following adrenalectomy for primary aldosteronism. Surgery. 2018;163(1):183-90. https://pubmed.ncbi.nlm.nih.gov/29129366 https://doi.org/10.1016/j.surg.2017.07.034
.Mai X, Kometani M, Yoneda T. Spontaneous remission of primary aldosteronism with mineralocorticoid receptor antagonist therapy: A review. Int J Mol Sci. 2022;23(22):13821. https://pubmed.ncbi.nlm.nih.gov/36430298 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9698409 https://doi.org/10.3390/ijms232213821
Gadallah MF, Kayyas Y, Boules F. Reversible suppression of the renin-aldosterone axis after unilateral adrenalectomy for adrenal adenoma. Am J Kidney Dis. 1998;32(1):160-3. https://pubmed.ncbi.nlm.nih.gov/9669438 https://doi.org/10.1053/ajkd.1998.v32.pm9669438
Starker LF, Christakis I, St Julien J, et al. Considering postoperative functional hypoaldosteronism after unilateral adrenalectomy. Am Surg. 2017;83(6):598-604. https://pubmed.ncbi.nlm.nih.gov/28637561
Yorke E, Stafford S, Holmes D, et al. Aldosterone deficiency after unilateral adrenalectomy for Conn's syndrome: A case report and literature review. Int J Surg Case Rep. 2015;7C:141-4. https://pubmed.ncbi.nlm.nih.gov/25604311 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336421 https://doi.org/10.1016/j.ijscr.2015.01.013
Taniguchi R, Koshiyama H, Yamauchi M, et al. A case of aldosterone-producing adenoma with severe postoperative hyperkalemia. Tohoku J Exp Med. 1998;186(3):215-23. https://pubmed.ncbi.nlm.nih.gov/10348217 https://doi.org/10.1620/tjem.186.215
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Jie En Tan, Nor Shaffinaz Yusoff Azmi Merican, Shartiyah Ismail, Noor Rafhati Adyani Abdullah

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The full license text is available at: http://creativecommons.org/licenses/by-nc/3.0/legalcode.
To request permission to translate, reproduce, download, or use articles or images for commercial reuse or business purposes from the Journal of the ASEAN Federation of Endocrine Societies (JAFES), kindly complete the Permission Request for Use of Copyrighted Material Form and email jafes@asia.com or jafes.editor@gmail.com.
A written agreement will be issued to the requester once permission has been granted.





