Endocrine Abstracts

Background: Primary aldosteronism (PA), or Conn’s syndrome, is a common cause of endocrine hypertension, typically due to aldosterone-producing adenomas. Unilateral adrenalectomy is the standard treatment, but secondary hypoaldosteronism post-surgery is a rare and clinically significant complication.

Case Presentation: We report a case involving a 76-year-old male diagnosed with Primary Aldosteronism in July 2019. His medical history included hypertension, hypokalaemia, chronic kidney disease, dyslipidaemia, and osteoarthritis. Investigations revealed an aldosterone-renin ratio >3400, confirmed by a saline infusion test. MRI identified a right adrenal adenoma (3 × 2 cm), which was functionally active on adrenal venous sampling. The patient underwent right adrenalectomy in July 2020. Postoperatively, he developed persistent hypoaldosteronism, presenting with hyperkalaemia (serum potassium above 5.4 mmol/l). Fludrocortisone replacement therapy was initiated, leading to normalization of potassium levels.

Discussion: Post-adrenalectomy hypoaldosteronism affects approximately 5% of patients treated for PA. Risk factors include advanced age, preoperative hypokalaemia, persistent hypertension, and impaired renal function. The condition may arise due to insufficient aldosterone production from the remaining adrenal gland, which may not respond adequately to renin-angiotensin feedback. This case highlights the importance of recognizing hypoaldosteronism as a potential sequelae, particularly in patients with predisposing factors.

Conclusion: Secondary hypoaldosteronism following adrenalectomy for Conn’s syndrome, though uncommon, can lead to significant electrolyte disturbances and requires long-term monitoring. Awareness of risk factors and early intervention with mineralocorticoid replacement are essential to prevent complications. This case underscores the need for individualized postoperative care and vigilance in patients undergoing adrenalectomy for Primary Aldosteronism.