Manejo quirúrgico del hiperaldosteronismo primario: un caso de suprarrenalectomía laparoscópica en una paciente joven

Hugo Javier Benítez Rios; Iván Alberto Núñez Guerrero; Sol Thalía Silvero Prieto; Daniel Fernández González

doi:10.53732/rccsalud/e8909

Authors

Hugo Javier Benítez Rios Universidad Nacional de Asunción, Facultad de Ciencias Médicas. Asunción, Paraguay https://orcid.org/0009-0007-6996-9150
Iván Alberto Núñez Guerrero Universidad Nacional de Asunción, Facultad de Ciencias Médicas. Asunción, Paraguay https://orcid.org/0009-0002-6799-0021
Sol Thalía Silvero Prieto Instituto de Previsión Social. Asunción, Paraguay https://orcid.org/0009-0007-0195-9132
Daniel Fernández González Instituto de Previsión Social. Asunción, Paraguay https://orcid.org/0009-0005-1616-5269

DOI:

https://doi.org/10.53732/rccsalud/e8909

Keywords:

hyperaldosteronism, adrenocortical adenoma, adrenalectomy, hypertension, hypokalemia, laparoscopy

Abstract

Primary hyperaldosteronism (PHA) due to an adrenal adenoma is a curable cause of hypertension. We present the case of a 34-year-old woman with a history of preeclampsia and refractory hypertension who presented with palpitations and was diagnosed with PHA. Imaging studies revealed a left adrenal mass consistent with an adenoma. The patient underwent laparoscopic left adrenalectomy, a minimally invasive procedure; pathology confirmed a cortical adenoma. Postoperatively, complete resolution of hypokalemia and significant blood pressure control were observed, allowing discontinuation of antihypertensive medication. This case highlights the success of laparoscopic adrenalectomy as the most appropriate treatment for unilateral PHA and underscores the importance of timely diagnosis and a multidisciplinary approach.

References

Rossi GP, Rossi FB, Guarnieri C, Rossitto G, Seccia TM. Clinical management of primary aldosteronism: an update. Hypertension. 2024;81(9):1845-1856. https://doi.org/10.1161/hypertensionaha.124.22642

Vaidya A, Hundemer GL, Nanba K, Parksook WW, Brown JM. Primary aldosteronism: state-of-the-art review. Am J Hypertens. 2022;35(12):967-988. https://doi.org/10.1093/ajh/hpac079

Lu YT, Zhang D, Zhang Q, Zhou ZM, Yang KQ, Zhou XL, et al. Apparent mineralocorticoid excess: comprehensive overview of molecular genetics. J Transl Med. 2022;20:500. https://doi.org/10.1186/s12967-022-03698-9

Tian J, Xiang F, Wang L, Wu X, Shao L, Ma L, et al. Liddle syndrome with a SCNN1A mutation: a case report and literature review. Kidney Blood Press Res. 2024;49(1):831-838. https://doi.org/10.1159/000540522

Faconti L, Kulkarni S, Delles C, Kapil V, Lewis P, Glover M, et al. Diagnosis and management of primary hyperaldosteronism in patients with hypertension: a practical approach endorsed by the British and Irish Hypertension Society. J Hum Hypertens. 2024;38(1):8-18. https://doi.org/10.1038/s41371-023-00875-1

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(11):2453-2495. https://doi.org/10.1210/clinem/dgaf284

Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment. J Clin Endocrinol Metab. 2016;101(5):1889-1916. https://doi.org/10.1210/jc.2015-4061

Araujo-Castro M, Parra Ramírez P, Hanzu FA. Executive summary of the Spanish consensus for the diagnosis, management, and follow-up of primary hyperaldosteronism. Endocrinol Diabetes Nutr (Engl Ed). 2024;71(8):355-364. https://doi.org/10.1016/j.endinu.2024.05.007

Yang J, Bell DA, Carroll R, Chiang C, Cowley D, Croker E, et al. Adrenal vein sampling for primary aldosteronism: Recommendations from the Australian and New Zealand Working Group. Clin Endocrinol. 2025;102(1):31-43. https://doi.org/10.1111/cen.15139

Zhou Y, Zhang M, Ke S, Liu L. Hypertension outcomes of adrenalectomy in patients with primary aldosteronism: a systematic review and meta-analysis. BMC Endocr Disord. 2017;17:61. https://doi.org/10.1186/s12902-017-0209-z

Worapaka Manosroi W, Atthakomol P, Phinyo P, Inthaphan P. Predictors of clinical success after unilateral adrenalectomy in primary aldosteronism: a systematic review and meta-analysis. Front Endocrinol (Lausanne). 2022;13:925591. https://doi.org/10.3389/fendo.2022.925591

Marzano L, Ronco C. Clinical and biochemical outcomes after adrenalectomy for primary aldosteronism in tertiary and quaternary referral centers: data from SOPRANO study. Hypertens Res. 2024;47(3):721-734. https://doi.org/10.1038/s41440-023-01554-x

Marzano L, Zoccatelli F, Pizzolo F, Friso S. Adrenalectomy versus medical therapy in primary aldosteronism: a meta-analysis of long-term cardiac remodeling and function (MATCH study). Hypertension. 2025;82(8):e142-e153. https://doi.org/10.1161/hypertensionaha.125.25104

Farina M, Pederzoli R, Rodríguez A, López G, Sosa E. Suprarrenalectomía videolaparoscópica transperitoneal: nuestra experiencia. Rev. Cir Parag. 2016;40(2):19-20. https://doi.org/10.18004/SOPACI.NOVIEMBRE.19-20

Falcón de Legal N, Ascurra M. Tumores de corteza suprarrenal en Paraguay: un desafío actual para la clínica, la genética y la salud pública. Medicinae Signum. 2025;4(1):46-58. https://revistas.unc.edu.py/index.php/fmunc/article/view/390

González González NR, González Chamorro CE, Bobadilla Segovia MN, Gómez Jara ML, Franco Bogado FA. Hipertensión arterial secundaria a hiperaldosteronismo primario. Rev Nac (Itauguá). 2019;11(1):116-123. https://scielo.iics.una.py/pdf/hn/v11n1/2072-8174-hn-11-01-116.pdf

Naruse M, Tanabe A, Yamamoto K, Rakugi H, Kometani M, Yoneda T, et al. Adrenal venous sampling for subtype diagnosis of primary hyperaldosteronism. Endocrinol Metab (Seoul). 2021;36(5):965-973. https://doi.org/10.3803/enm.2021.1192

Huang CW, Chen YC, Wu VC, Wang SM, Chueh JS, Lee BC, et al. Major adverse cardiovascular events in primary aldosteronism: adrenalectomy vs mineralocorticoid receptor antagonists. J Am Heart Assoc. 2025;14(3):e038714. https://doi.org/10.1161/JAHA.124.038714

Saadi A, Perazella M, Dekkers T, Williams TA, Rossi GP, Beuschlein F, et al. Predictors of successful outcome after adrenalectomy for unilateral primary aldosteronism. Front Endocrinol (Lausanne). 2023;14:1205988. https://doi.org/10.3389/fendo.2023.1205988